OBJECTIVES: I. Compare the long term outcomes in patients with giant cell arteritis after glucocorticoid treatment with or without methotrexate.
II. Compare remission relapse rates in these patients after glucocorticoid therapy with or without methotrexate.
III. Determine whether adjunctive use of methotrexate lowers cumulative dose and duration of glucocorticoid therapy and whether there is less treatment related morbidity and mortality.
IV. Demonstrate the feasibility of long term, double blind, placebo controlled, randomized, multicenter trials for treatment of systemic vasculitides.
PROTOCOL OUTLINE: This is a randomized, double blind, multicenter study. Patients are randomized into initial therapy with prednisone plus weekly placebo or prednisone plus weekly oral methotrexate. Patients who do not respond to treatment within 5 days are taken off study. If methotrexate toxicity dose not occur after 2 weeks, methotrexate is increased by one tablet per week until a maximum tolerated dose (MTD) is achieved. The MTD of methotrexate or the matching placebo dose is continued for 12 months in the absence of toxicity. Once 12 continuous months of remission are achieved, methotrexate or placebo is tapered to discontinuation.
Patients are followed for 1-6 years.
Completion date provided represents the completion date of the grant per OOPD records
PROTOCOL ENTRY CRITERIA:
--Disease Characteristics--
Diagnosis of giant cell arteritis (GCA) by at least one of the following:
Westergren erythrocyte sedimentation rate of at least 40 nm in one hour
--Prior/Concurrent Therapy--
Endocrine therapy: No greater than 20 days since initiation of prednisone therapy
Other: No concurrent sulfa drugs or nonsteroidal antiinflammatory drugs
--Patient Characteristics--
Hematopoietic:
Hepatic:
Renal: Creatinine less than 2.0 mg/dL
Other: