#5-33E. Preventing Giant Cell Arteritis Flares: Two-Year Outcomes of Upadacitinib Continuation (Ann Rheum Dis, 2026)

How do we balance glucocorticoid withdrawal with the high risk of relapse in giant cell arteritis (GCA)? This clinical dilemma is addressed in the SELECT-GCA trial, which evaluated the efficacy and safety of upadacitinib 15 mg continuation versus withdrawal through 2 years. The landmark finding is that continuing upadacitinib 15 mg reduced the risk of disease flare by approximately 92% (7.4% vs. 59.5%) compared with switching to placebo, while achieving a substantial 1-gram reduction in cumulative glucocorticoid exposure with a consistent safety profile. However, clinicians must critically interpret these results considering potential survivor bias, as the trial re-randomized only those patients who had successfully achieved at least 24 weeks of consecutive remission by week 52, which may limit generalizability to patients with more refractory disease. Nonetheless, this study offers vital guidance for daily practice, demonstrating that extending selective JAK-1 inhibitor therapy beyond one year provides a robust, steroid-sparing strategy to prevent flares and safely sustain long-term GCA control.

Citation: Wolfgang A. Schmidt, Arathi R. Setty, Christian Dejaco, Andrea Rubbert-Roth, Maria C. Cid, Tomonori Ishii, Lisa Christ, Avani D. Joshi, Nathaniel Zerad, Aditi Kadakia, Shaofei Zhao, Weihan Zhao, Ivan Lagunes, Charles Phillips, Daniel Blockmans, Peter A. Merkel. Clinical outcomes of upadacitinib continuation vs withdrawal in giant cell arteritis through 2 years. Annals of the Rheumatic Diseases. 2026. DOI: 10.1016/j.ard.2026.06.029 URL: https://doi.org/10.1016/j.ard.2026.06.029

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