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2016 ; 95
(42
): e4974
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Steroid-sparing effect and toxicity of dapsone treatment in giant cell arteritis:
A single-center, retrospective study of 70 patients
#MMPMID27759628
Ly KH
; Dalmay F
; Gondran G
; Palat S
; Bezanahary H
; Cypierre A
; Fauchais AL
; Liozon E
Medicine (Baltimore)
2016[Oct]; 95
(42
): e4974
PMID27759628
show ga
Although a glucocorticoid (GC)-sparing strategy is needed for patients with giant
cell arteritis (GCA) suffering from refractory disease or serious
treatment-related complications, evidence of efficacy in this setting of
immunosuppressive drugs and biotherapies is lacking. Herein, we evaluated the
GC-sparing effects and tolerability of addition of dapsone (DDS) to prednisone
therapy in patients with GCA. We retrospectively assessed data on 18 GCA patients
who received DDS as a first-line treatment (DDS-1 group) and 52 patients who
received it as a second- or third-line treatment for refractory GCA, with or
without excessive GC-related toxicity (DDS-2 group). Of these 70 patients, 63
belonged to an inception cohort of 478 patients, whereas the remaining 7 were
referred to our department for resistant GCA. In all, 52 patients were assessable
for DDS efficacy. The baseline characteristics of the DDS-1 patients were similar
to those of 395 GCA patients (control group) who received prednisone alone. DDS-1
patients had a more sustained decrease in GC dose with a lower mean prednisone
dose at 12 months, and they comprised higher proportions who achieved GC
withdrawal within the first year, who stopped prednisone treatment, and who
recovered from GCA (P?0.001 for each variable). Patients in the DDS-2 group
achieved a mean rate of prednisone reduction of 65% and a prednisone dose
reduction of 16.9?±?13.3?mg/d. The monthly decreases in the prednisone dose were
2.4 and 1.25?mg in DDS-1 and DDS-2 patients, respectively. DDS-induced side
effects were recorded in 44 (64%) assessable patients. These side effects led to
lowering of the DDS dose by 25?mg/d in 11 (16%) patients and permanent cessation
of DDS in 14 patients (20%), due to allergic skin rash in 7, agranulocytosis in
2, icteric hepatitis in 2, and excessive hemolysis in 2 patients. DDS is a potent
GC-sparing agent in GCA that should be evaluated in prospective studies. However,
DDS use should be restricted to refractory GCA patients due to its toxicity, and
close clinical and laboratory monitoring for 3 months is necessary.
|*Drug Tolerance
[MESH]
|*Forecasting
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Anti-Infective Agents/adverse effects/therapeutic use
[MESH]