Adverse Events Common With Glucocorticoids for Polymyalgia Rheumatica

Although glucocorticoid treatment reduced inflammatory parameters in real-world patients with polymyalgia rheumatica (PMR), more than a third still showed above-normal levels throughout a 52-week follow-up period, according to study results published online ahead of print in the journal Joint Bone Spine.

“Moreover, glucocorticoid [treatment] was withdrawn by week 52 in few patients, and the incidence of osteoporosis and diabetes increased with the glucocorticoid dose,” wrote a research team from Japan. “These results emphasize the need for glucocorticoid-sparing strategies in PMR treatment.”

For the study, researchers used electronic medical record data to analyze the use of glucocorticoid therapy in 373 patients with PMR in Japan. The average patient age was 77 years.

Among patients, the initial daily glucocorticoid dose was a median 15 mg. By week 52, the median daily dose had decreased to 3.5 mg/day, according to the study. The median cumulative dose at week 52 was 2455 mg.

Before starting glucocorticoids, patients had a median C-reactive protein (CRP) level of 64.3 mg/L, which over treatment weeks 4 through 52 decreased to a median 1.4–3.2 mg/L, the study found. However, at week 52, 39% of patients had a CRP level above 3 mg/L, which is considered the upper limit of normal.

Glucocorticoid-related adverse events were common. The 52-week cumulative incidence of new-onset adverse events was 49% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 4.3% for serious infection, and 2.9% for glaucoma, researchers reported. For osteoporosis and diabetes, the incidence tended to rise with glucocorticoid doses.

“The study results suggest that the current therapeutic strategy for PMR with a single glucocorticoid is inadequate,” researchers wrote. “Besides promoting the use of methotrexate—currently recommended by the European League Against Rheumatism/American College of Rheumatology as a glucocorticoid-sparing strategy—it is essential to develop new treatment strategies that effectively control PMR disease activity while minimizing glucocorticoid use.”

Reference

Tanaka Y, Tanaka S, Fukasawa T, et al. Glucocorticoid treatment and clinical outcomes in patients with polymyalgia rheumatica: a cohort study using routinely collected health data. Joint Bone Spine. Published online December 22, 2023. doi:10.1016/j.jbspin.2023.105680