Giant Cell Arteritis

Prescribing Notes:

• A steroid card should be given when appropriate. See the Healthcare Improvement Scotland website for details around the use of a Steroid Emergency Card.
• Prophylactic bone protection should be considered in patients anticipated to receive any dose of prednisolone daily for longer than 3 months. See ‘Corticosteroid-induced osteoporosis (treatment and prevention)’ pathway.
• Bone loss is related to the cumulative dose of glucocorticoids and preventative measures should therefore be considered in patients receiving >7.5mg daily for 3 months or longer or intermittent courses of prednisolone resulting in a cumulative dose of 250mg or more in 3 months (or equivalent dose of other glucocorticoid).
• For patients with swallowing difficulties, prednisolone oral solution or soluble tables may be considered. Prednisolone tablets may be dispersed in water as an alternative to soluble tablets or oral solution preparations. This is an off-label use but more cost-effective option. Refer to local board policies on the use of unlicensed (and off-label) medicines for further guidance. 
• Prednisolone 25mg tablets should only be used for doses above 40mg. 
• Long-term steroids should be withdrawn gradually.
• Tocilizumab is recommended for the treatment of Giant Cell Arteritis (GCA) in adult patients. It is however subject to a 12 month clinical stopping rule. Treatment beyond 52 weeks should be guided by disease activity, physician discretion and patient choice. Treatment beyond 12 months is outwith SMC advice.
• All biosimilar medicines should be prescribed by brand name in line with national guidance for the use of biosimilar medicine.