High rates of long-term glucocorticoid use in people with GCA, PMR
medwireNews: Real-world study results suggest that less than a third of patients with giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR) are able to discontinue glucocorticoid treatment for at least 6 months, and a substantial proportion remain on prednisone for at least 2 years.
“[A]ccording to current guidelines, the expectation is that patients will eventually either discontinue glucocorticoids or reach a dose of ≤ 5 mg/day after 1 year,” explain Gary Craig (Arthritis Northwest, Spokane, Washington, USA) and co-authors.
However, in the current investigation, just 32% of 81 patients with GCA, 32% of 779 with PMR, and 27% of 97 patients with both conditions discontinued glucocorticoids for 6 months or more during a 2-year period. A total of 17%, 23%, and 18% of patients, respectively, discontinued for at least 6 months and remained glucocorticoid-free at the 2-year follow-up.
The study drew on electronic health records from people aged at least 50 years who attended a US rheumatology clinic in 2006–2017 and had at least one glucocorticoid prescription. At baseline, patients were aged an average of 70 years, 64.2% were women, and the average prednisone dose was 46.7 mg/day for patients with GCA only, 20.1 mg/day for those with PMR only, and 29.0 mg/day for those with both conditions.
Craig and team found that the median time between baseline and glucocorticoid discontinuation for at least 6 months was significantly shorter for patients with both GCA and PMR (157 days) compared with those with GCA (213 days) or PMR (204 days) alone. They say that the majority of patients required daily prednisone treatment at the 2-year follow-up, with average daily doses of 9.5 mg, 8.8 mg, and 12.6 mg for those with GCA, PMR, and both conditions, respectively.
The researchers note that their findings remained consistent “regardless of the initial prednisone dose.” For instance, among GCA patients, 32.6% of the 46 people with a baseline dose of less than 60 mg/day discontinued treatment for at least 6 months, as did 31.4% of the 35 people with a baseline dose of at least 60 mg/day. A corresponding 19.6% and 14.3% remained off glucocorticoids at the 2-year follow-up.
Taken together, these findings point to a “higher-than-anticipated number of patients with continued disease and exposure to glucocorticoids at 2 years,” suggesting “a more chronic nature of GCA and PMR in this real-world study rather than the existing expectation that GCA and PMR often resolve within 2 years of therapy,” write the authors in Rheumatology and Therapy.
They conclude that their results “highlight the need for the use of more efficacious and glucocorticoid-sparing therapies in patients with GCA and/or PMR.”
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