Article

Treatment With Angiotensin II Receptor-Blockers Is Associated With Prolonged Relapse-Free Survival, Lower Relapse Rate And Corticosteroid Sparing Effect In Patients With Giant Cell Arteritis

Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
Seminars in arthritis and rheumatism (Impact Factor: 3.63). 10/2013; DOI: 10.1016/j.semarthrit.2013.10.009

ABSTRACT Objective
To determine whether concomitant treatment with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is associated with changes in the outcome of patients with giant cell arteritis (GCA).

Methods
A study cohort of 106 patients with biopsy-proven GCA was longitudinally followed for 7.8 ± 3.3 years. Patients were stratified according to their treatment with ACEI, ARB, or no ACEI/ARB. Time to first relapse, number of flares, time to achieve a stable prednisone dose <10 mg/day and <5 mg/day with no relapses, time required to completely discontinue prednisone, cumulative dose of prednisone received during the first year and concentrations of acute-phase reactants at pre-defined time points (baseline, 6, 12, 18 and 24 months) were compared among the 3 groups. Cox proportional hazards models were performed to adjust for potential confounders.

Results
Patients receiving ARB presented a significantly longer relapse-free survival than patients treated with ACEI or patients not receiving ACEI/ARB (p=0.02). The adjusted hazard ratio for relapses in patients treated with ARB was 0.32 (95% CI 0.12-0.81, p=o.017). In addition, patients who received ARB achieved a prednisone maintenance dose <10 mg/day faster than all other patients (p=0.0002). No significant differences were observed among groups in acute-phase reactant levels during follow-up. However, patients not receiving ACEI/ARB had significantly higher C-reactive protein and haptoglobin concentrations than those receiving ACEI or ARB at various time-points.

Conclusions
Addition of ARB to glucocorticoids is associated with lower relapse rate and more prolonged disease-free survival in patients with GCA.

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