Immunosuppressive Therapy in Giant Cell Arteritis: Do Steroids Still Reign Supreme?

Giant cell arteritis (GCA) is the most common vasculitis in adults, and patients with GCA often present with vision loss that may progress to permanent blindness. For this reason, empirical treatment with corticosteroids is initiated when there is reasonable suspicion of GCA. Corticosteroids have remained the mainstay of treatment for GCA for the past 70 years due to their profound immunosuppressive effects. However, not all patients tolerate or respond adequately to corticosteroids, and prolonged dosages increase the risk for adverse side effects. There have also been recent advances and investigations into alternative immunosuppressive therapies for GCA; specifically, interleukin 6 inhibitors and other alternatives have been approved by the American College of Rheumatology and European League Against Rheumatism for adjunctive use with corticosteroids or for refractory GCA. However, it is unclear whether current immunosuppressive alternatives can conclusively replace corticosteroids in the treatment of GCA and prevention of vision loss. This article reviews the robust immunosuppressive mechanisms of corticosteroids and summarizes clinical investigations of alternative therapies for GCA.