THU0434 Predictors of long-term glucocorticoid therapy in polymyalgia rheumatica: discontinuation is more common for patients treated with aminobisphosphonates
Authors: A. Giollo, F. Bettili, F. Ghellere, O. Viapiana, L. Idolazzi, D. Gatti, M. Rossini
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Glucocorticoids (GCs) are the cornerstone of polymyalgia rheumatica (PMR) therapy. Although guidelines for PMR generally recommend tapering GCs after 12–24 months, most patients are unable to discontinue GCs within the recommended time-frame. However, glucocorticoid-related adverse events can occur in up to 85% of treated cases. Patients treated with GCs should receive aminobisphosphonates (N-BPs) for the prevention of GCs-induced osteoporosis. <h3>Objectives</h3> In this retrospective observational study, we aimed to establish: 1) the proportion of patients with PMR who do not discontinue GCs, and 2) whether the use of N-BPs may be associated with a discontinuation of GCs. <h3>Methods</h3> Data were collected from electronic medical records of Rheumatology Unit at Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Italy. Patients were eligible for inclusion if they fulfilled the 2012 EULAR/ACR classification criteria for PMR. The following exclusion criteria were applied: a history of large vessel vasculitis and other diagnoses that could explain the symptoms. The main outcome was the long-term use of GCs, defined as a patient still receiving active treatment with GCs at the last evaluation available. Putative predictors included age, sex, dosage of prednisone, inflammatory markers (ESR and CRP), haemoglobin, peripheral joint involvement, use of DMARDs, number of relapses, osteoporosis and use of N-BPs. Univariable and multivariable Cox regression analyses were used to examine the association between several predictors and the outcome. <h3>Results</h3> 385/467 patients screened were eligible (median age 72 years [IQR 66–78], 64% females). Peripheral joint involvement was detected in 29%; 22% received DMARDs. The initial prednisone dose (median daily dose 20 mg<sup>13–25</sup>) was correlated with age, haemoglobin, CRP and ESR. More than 60% of patients were treated with N-BPs, of whom only 26% were diagnosed with osteoporosis. The median follow up time was 38 months [IQR 9–57]. Disease relapse occurred in 307/467 patients (80%). GCs were discontinued in 47% after a median time of 20 months [IQR 14–27], but were restarted in 39%. At the last evaluation, 276 patients (72%) were still receiving active treatment with GCs (median daily dose 5 mg [IQR 0–8]). Multiple Cox regression analysis showed that older age (HR 1.02, 95% CI 1.00–1.04, p=0.006) and higher CRP at baseline (HR 1.24, 95% CI 1.10–1.40, p=0.001) were associated with the long-term use of GCs, whereas significant predictors of a shorter treatment duration were the use of N-BPs (HR 0.66, 95% CI 0.50–0.88, p=0.004; figure 1) and a higher initial prednisone dose (HR 0.98, 95% CI 0.96–0.99, p=0.002). Adjusted HR 0.66 (95% CI: 0.50, 0.88), p=0.004. <h3>Conclusions</h3> Unlike current guidelines, in clinical practice a long-term treatment with GCs is often necessary in PMR. There is need to investigate novel treatments for PMR. This preliminary data suggests that aminobisphoshonates may have a role in the management of PMR. <h3>Disclosure of Interest</h3> None declared