International practice patterns and beliefs concerning intravenous methylprednisolone and low-dose aspirin in giant cell arteritis.

Abstract

Background: The use of intravenous glucocorticoids (IVGCs) and low-dose acetylsalicylic acid (ASA) in giant cell arteritis (GCA) remains controversial, with limited evidence and heterogeneous guideline recommendations. We conducted an international survey to characterise current practice patterns, clinical equipoise, and trial design priorities.

Methods: A cross-sectional online survey was distributed internationally to clinicians involved in GCA care between December 2025 and January 2026. Questions addressed demographics, prescribing practices, motivations and barriers, and preferred outcomes for clinical trials evaluating ASA and IVGCs. Descriptive analyses were performed.

Results: A total of 155 respondents from five continents were included, predominantly rheumatologists (51.0%) and ophthalmology specialists (33.5%). ASA was initiated in a minority of patients (median 15%), primarily for stroke prevention, with major barriers including lack of disease-specific evidence and bleeding risk. Clinical equipoise regarding ASA was reported by 69.5%, and 71.6% expressed interest in trial participation. IVGCs were widely used for visual involvement, particularly permanent vision loss, though substantial variability existed in indications and dosing. Equipoise for IV versus oral glucocorticoids was reported by 68.5%, with strong interest in trial participation (71.2%). Across both interventions, respondents prioritised clinically meaningful outcomes such as stroke, contralateral vision loss, and major adverse cardiovascular events.

Conclusions: This international survey demonstrates significant heterogeneity and persistent clinical uncertainty in the use of ASA and IVGCs in GCA. High levels of equipoise and willingness to participate in trials highlight the urgent need for randomised studies to inform evidence-based practice.