Would you add a DMARD such as methotrexate for a patient with GCA and partial response to tocilizumab but inability to taper prednisone below 10mg daily?
Alternatively would you change therapy entirely to upadacitinib and consider this a tocilizumab failure?
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In a patient with giant cell arteritis (GCA) on tocilizumab who has had a partial response but cannot taper prednisone below 10 mg/day, would you add a DMARD such as methotrexate?
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1 Answer
Mednet MemberInvited Expert
Rheumatology · Massachusetts General Hospital
Answered on
This is a clinical scenario that comes up relatively frequently, but unfortunately, there is a lack of data to guide this decision, and both approaches are reasonable. On balance, methotrexate has been demonstrated to have a moderate effect with respect to steroid sparing and reducing relapses in GCA, although three randomized studies on this subject have reached disparate conclusions. Furthermore, there have been no randomized studies on the impact of adding MTX to tocilizumab. However, 10 mg o...
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