Treatment Patterns and Clinical Outcomes for Patients Living with Active Giant Cell Arteritis in Canada
Bibliographic record
Abstract
INTRODUCTION: Giant cell arteritis (GCA) is a chronic inflammatory vasculitis in large and medium-sized arteries. Glucocorticoids (GCs) remain the cornerstone of treatment but carry significant long-term adverse effects. Tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, has become a GC-sparing agent, yet optimal treatment duration remains uncertain. METHODS: This retrospective cohort study evaluated treatment patterns, clinical outcomes, and GC burden in patients (N = 121) with GCA treated at a specialized clinic in Montreal, Canada, between January 2017 and February 2025. Patients were stratified by initial treatment: GC only, GC + TCZ, and GC + other immunosuppressants (OIS). The primary endpoint was sustained remission at 12 months, defined by symptom resolution and normalization of inflammatory markers maintained for ≥ 6 months. RESULTS: Overall, two-thirds of patients (83, 68.6%) (95% confidence interval [CI] 60.3-76.9%) achieved sustained remission, with similar rates in GC only (35, 72.9%) and GC + TCZ (44, 69.8%) groups, but lower in the GC + OIS group (4, 40.0%). Most patients remained on GCs after 1 year, highlighting the difficulty of achieving steroid-free remission. Relapses occurred in nearly half of patients (58, 47.9%), with a median time to first relapse of 283.5 days (95% CI 206-326). Methotrexate showed limited GC-sparing efficacy, with several patients relapsing (6, 60%). TCZ-treated patients had the lowest cumulative GC exposure (mean 3431 mg (standard deviation [SD] = 1049) vs. 4690 mg (SD 969) in GC only), though a quarter of patients (16, 25.4%) relapsed after TCZ discontinuation. CONCLUSION: The current 1-year TCZ treatment limit in Canada may be inadequate for long-term disease control. Adverse events were generally low, though hypertension, hyperglycemia, and infections were common. Two bowel perforations occurred in the TCZ group. These findings underscore the need for individualized, long-term treatment in GCA to minimize steroid exposure and maintain disease control. Future research should explore optimal therapy durations and support policy changes to expand access to steroid-sparing agents to improve long-term GCA outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".