Despite the need for treatment, these patients declined steroid therapy because of their comorbidities, according to Dr. Nannini.
They did, however, consent to treatment with adalimumab (40 mg) every 2 weeks.
After 1 month of therapy, all three were in remission, with ESRs less than 20 mm/hour, CRPs less than 0.5 mg/dL, and no remaining musculoskeletal, cranial, or systemic symptoms.
After 6 months, the adalimumab dosage was reduced to 40 mg once monthly; after 12 months of therapy, the drug was discontinued in two of the three patients. They remain in remission 4 and 5 months later, whereas the third patient is completing 1 year of treatment with good response.
“Comorbidities such as diabetes, hypertension, and osteoporosis are very common among patients with GCA, highlighting the need for corticosteroid-sparing agents. … Our limited experience with adalimumab suggests that the drug may represent an effective alternative to corticosteroids in patients with GCA who had corticosteroid dose-limiting comorbidities,” she concluded.
Dr. Pipitone described these findings with adalimumab as “quite intriguing.” He added, however, “I don't think we can make a case for the use of TNF blockers in clinical practice, at least not at this stage.”
Neither Dr. Pipitone nor Dr. Nannini reported conflicts of interest.