Purchase this article with an account.
S.R. Montezuma, J.F. Rizzo, G.A. March; Meta-Analysis of the Dosage of Corticosteroid Therapy in Giant Cell Arteritis: Attention to Three Clinically Relevant Questions . Invest. Ophthalmol. Vis. Sci. 2003;44(13):623.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: The recommended levels of corticosteroid therapy in giant cell arteritis (GCA) vary widely, and the lack of randomized, controlled studies on this issue constrains clinicians to a non-evidence based style of practice. Methods: Retrospective review of all GCA cases in the English language literature that contained sufficient clinical information to permit analysis of the following questions: 1) What dose of corticosteroid is recommended to prevent visual loss in patients who have no visual symptoms? 2) What dose of corticosteroid is recommended to protect the second eye of patients who present with monocular visual loss? 3) Is the potential for reversal of visual loss related to the corticosteroid dose? Results: Regarding question 1, only 11 cases (given > 25 mg/day prednisone) were identified in which blindness developed after prednisone therapy. Seven of the 11 "failures" occurred in patients given < 80 mg/day. Regarding question 2, 17 cases of blindness that developed in the initially asymptomatic second eye within the first month of therapy were identified. Nine of these 17 "failures" occurred with initial doses < 80 mg/day. Regarding question 3, there were 39 cases of visual improvement after initiation of corticosteroid therapy. None occurred on < 60 mg/day. Thirty-four of the 39 patients initially received 80 mg of corticosteroid or higher. Conclusions: There is an inherent bias in the literature in that most patients treated for GCA receive relatively low (40 mg or less) initial doses of prednisone. As such, it is not surprising that the majority of cases of visual loss (i.e. questions 1 and 2) occurred with lower doses of corticosteroid. It is therefore of some interest that the result for question 3 showed that higher doses were much more likely to be associated with visual recovery. Although a reporting bias also applies to question 3, this review suggests that higher doses of corticosteroid might be associated with a greater tendency to visual recovery in GCA, which is generally an uncommon occurrence.
This PDF is available to Subscribers Only