BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis

Foré, R; Liozon, E; Dumonteil, S; Sené, T; Héron, E; Lacombe, V; Leclercq, M; Magnant, J; Beuvon, C; Régent, A; de Mornac, D; Samson, M; Smets, P; Alexandra, JF; Granel, B; Robert, PY; Curumthaullee, MF; Parreau, S; Palat, S; Bezanahary, H; Ly, KH; Fauchais, AL; French study group for large-vessel arteritis (GEFA); Gondran, G

doi:10.1016/j.jbspin.2023.105641

Vasculitis & polymyalgia rheumatica

BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis

Joint Bone SpinePublished 20 Sep 2023Retrospective cohort study

Main finding · Bilateralisation (contralateral PVI)ResultOdds ratio 12.9 CI 3.4–94.3

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Authors' conclusion

Our data do not support the routine use of pulse IV-MP for GCA complicated by unilateral PVI to avoid bilateral ophthalmologic damage.

Study context

Population: New giant cell arteritis (GCA) with strictly unilateral permanent visual ischemia, 13 French hospital centres, past 15 years
Participants: 116 participants

Exposure: IV pulse methylprednisolone then oral prednisone vs direct prednisone 1mg/kg per day
Intravenous methylprednisolone (IV-MP)n = 86
Direct prednisonen = 30reference
Outcome: Early permanent visual ischemia of the second eye (contralateral PVI)
Follow-up: 1 month

Methodological detailsmulticentre, propensity score analysis

Multicentre
Propensity score analysis

Main finding

Bilateralisation (contralateral PVI)

Odds ratio

12.9

CI 3.4–94.3

P < 0.001

Events by group

IV-MP15.1%13 of 86

Direct prednisone3.3%1 of 30

IV-MPvs Direct prednisone

OR 12.9 (CI 3.4–94.3); P < 0.001

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	IV-MP	Direct prednisone
Visual acuity improvement of initially affected eye	0.02 LogMar	−0.28 LogMar
Visual acuity improvement, early management within 48hours of PVI onset (subgroup)	−0.11 LogMar	0.25 LogMar

Visual acuity improvement, early management within 48hours of permanent visual ischemia (PVI) onset (subgroup): n=61

Visual acuity improvement of initially affected eye

Not significantly associated with IV-MP

Safety

Complications attributable to corticosteroid therapy in the first month

P < 0.05

IV-MP31.8 %

Direct prednisone10.7%

Reference

Authors: Foré R, Liozon E, Dumonteil S, Sené T, Héron E, Lacombe V, et al.
All 24 authors
Foré R, Liozon E, Dumonteil S, Sené T, Héron E, Lacombe V, Leclercq M, Magnant J, Beuvon C, Régent A, de Mornac D, Samson M, Smets P, Alexandra JF, Granel B, Robert PY, Curumthaullee MF, Parreau S, Palat S, Bezanahary H, Ly KH, Fauchais AL, French study group for large-vessel arteritis (GEFA), Gondran G
Journal: Joint Bone Spine
Published: 20 Sep 2023
DOI: 10.1016/j.jbspin.2023.105641
PubMed: 37734440

Topic: Vasculitis & polymyalgia rheumatica

Exposure definitions

IV-MP: intravenous methylprednisolone, total dose between 900 and 5000mg, then prednisone

Key notes

No significant difference between the two strategies
Classical logistic regression, matching or stratification on propensity score did not show a significant association

More notes

Weighting on propensity score

Original publication

BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis. Joint Bone Spine. Published 20 September 2023. doi:10.1016/j.jbspin.2023.105641

Read the original article ↗

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