In contrast, in a study that included twice the number of patients and used a higher dosage of MTX, the adjunctive use of MTX was not significantly better than the use of corticosteroids alone in the management of GCA.13 Patients who were treated with MTX plus prednisone(Drug information on prednisone) did not have a significantly lower relapse rate than those treated with corticosteroids alone (57.5% vs 77.3%; P = .26). However, the MTX group did show a significantly lower rate of relapse that was heralded by PMR symptoms.
With such conflicting data, there is no uniform recommendation for the use of MTX in the management of GCA. Until additional data are available, we recommend the use of MTX only as a second-line agent in conjunction with corticosteroids and aspirin(Drug information on aspirin) for patients who are refractory to or intolerant of conventional corticosteroid therapy.
Although case reports and small case series suggested that targeted tumor necrosis factor α (TNF-α) inhibition might be useful in GCA management, the results of a recent randomized controlled trial appear to debunk this idea.17 The results of this trial, combined with the negative results of TNF-α inhibition strategies in other forms of vasculitis,18 greatly diminish enthusiasm for the use of infliximab(Drug information on infliximab) in GCA. Thus, to date, no therapeutic agent in GCA has been demonstrated to have a corticosteroid-sparing effect.