Glucocorticoids rarely required in granulocyte colony-stimulating factor-associated large-vessel vasculitis: Japanese cancer centre cohort.

Abstract

To evaluate the efficacy of glucocorticoid-sparing management in patients with G-CSF-associated large-vessel vasculitis (LVV). Patients with cancer diagnosed with LVV following G-CSF administration between April 2020 and December 2024 were included. Patients received non-glucocorticoid treatment, mainly NSAIDs, whereas those with an inadequate response to or intolerance of NSAIDs were treated with glucocorticoids. The primary outcome was the remission rate in patients treated without glucocorticoids. G-CSF-associated LVV occurred in 19 of 4708 patients (0.4%). The median age was 64 years (range: 53-79), and 73.7% were females. Breast cancer was the most common cancer type (36.8%). Pegfilgrastim was the most frequently used agent (94.7%). Of the 19 patients, 18 (94.7%) received non-glucocorticoid treatment: 15 (78.9%) with NSAIDs, one (5.3%) with acetaminophen and two (10.5%) under observation, all achieving remission (100%). NSAIDs were discontinued in one patient owing to liver dysfunction; however, no serious adverse events were observed. Another patient (5.3%) with renal dysfunction received glucocorticoids for 2 weeks. The median intervals from the last G-CSF administration to LVV onset, peak inflammation, remission and imaging remission were 7 (range: 2-15), 14 (10-19), 30 (14-49) and 51 (27-346) days, respectively. Filgrastim was subsequently administered to five patients (26.3%) who developed LVV following pegfilgrastim administration. All patients achieved remission and experienced no recurrence regardless of treatment. Glucocorticoid-sparing management of G-CSF-associated LVV may be a safe and effective approach.