Objective: To define the optimal corticosteroid dose regimen in the initial treatment of temporal arteritis (TA).
Methods: We conducted a retrospective long-term evaluation of the efficacy and toxicity of corticosteroid treatment in 77 TA patients treated with three different dose-regimens: group A starting at 30-40 mg/d of prednisone, group B > 40-60 mg/d, and group C > 60 mg/d.
Results: The 3 patient groups were similar with regard to the mean age, male/female ratio, mean duration of follow-up, percentage of positive temporal artery biopsies, and rate of steroid tapering. There was a positive correlation between the starting dose and the cumulative dose of steroids at one year. Treatment efficacy was similar among the groups: cumulative cure rates (i.e. patients off steroids without exacerbation of TA for 6 months or more) were 11-13%, 29-35%, and 48-50% after 1, 2, and 3 years, respectively. In addition, the rates of disease flare were similar among the groups after 3 years of follow up, although group C patients tended to have fewer TA exacerbations during the first year compared to the other groups. In contrast, group A patients developed significantly fewer steroid side effects: 36% compared to 78% and 88% in groups B and C.
Conclusion: The group A steroid regimen, starting with 30-40 mg/d and tapering to 10 mg/d within 6 months and to 5-7.5 mg/d within 1 year, was effective and less toxic in this patient population, than the two higher dose regimens.