POS1460-HPR PREVALENCE AND MANAGEMENT OF PATIENTS WITH COMORBIDITIES AND FRAILTY IN NEW ONSET POLYMYALGIA RHEUMATICA
Authors: S. E. Sattui, F. Buttgereit, M. Lidar, K. Ford, S. Fiore, L. Araujo, T. Beukelman, F. Xie, J. Curtis
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Polymyalgia rheumatica (PMR), a common inflammatory rheumatic disease in older adults, is primarily treated with glucocorticoids (GC). A high comorbidity burden in PMR may increase the risk of GC toxicity. Frailty, characterized by poor health outcomes and increased vulnerability to stressors is more frequent in PMR (17%) [1] than in community dwelling elderly (11%) [2]. There are limited data on the prevalence of patients with PMR and comorbidities or frailty that may warrant more personalized PMR management (earlier specialist care, screening, lower GC dose/faster taper). <h3>Objectives:</h3> To describe the prevalence and management over time of frailty and comorbidities in patients with new onset PMR that may result from or worsen due to long term GC use. <h3>Methods:</h3> An inception cohort of patients with PMR aged ≥50 years was identified in fee-for-service U.S. Medicare claims data from 10/1/2016 to 12/31/2019 with 1) no history of PMR or giant cell arteritis, 2) ≥1 inpatient or ≥2 outpatient PMR diagnosis codes (ICD-10-CM M35.3) ≥30 to &lt;365 days apart. Initial GC (prednisone equivalent) use had to be 7.5–25 mg/day ≤30 days after 1st inpatient code or from 1st outpatient to ≤30 days after 2nd outpatient code, ≥200 mg in first ≤30 days and continuous ≥ 4 months. Patients with seropositive rheumatoid arthritis, other systemic rheumatic disease, organ transplant, multiple sclerosis, active malignancy treatment or prescription for methotrexate, leflunomide, azathioprine or interleukin-6 receptor inhibitor during baseline were excluded. We report the prevalence of comorbidities (based on diagnosis, procedure or drug codes) that might be relative contraindications to long term GC use and frailty (assessed with a validated claims-based frailty index [CFI] [3]; defined as CFI ≥0.2 [4]), GC use, care by rheumatology, and screening with Dual-energy X-ray absorptiometry (DXA). <h3>Results:</h3> Of 5,499 patients with new onset PMR, at baseline 4.7%, 22.8% and 72.5%, had no, 1 and ≥2 comorbidities, respectively and frailty was seen in 33.8%. Patients with no vs. 1/≥2 comorbidities, and no frailty vs. frailty were younger (75.3 vs. 76.3/77.3; 76.5 vs. 77.9, years), fewer were female (49.2% vs. 54.7%/69.7%; 61.7% vs 72.5%) and fewer entered Medicare due to disability (7.8% vs 8.4%/14.5%; 8.8% vs 20.5%). Patients with no/1 vs. ≥2 comorbidities and frailty vs. no frailty were less likely to have ≥1 non excluded chronic inflammatory condition (asthma, psoriasis etc.) where GC may be used (41.1%/38.7% vs. 45.7%; 38.3% vs. 54.8%). Frailty occurred more in blacks vs. whites (43.1% vs. 33.4%). Comorbidities and frailty increased over 3 years, with a 4-fold increase in moderate-severe frailty (Table 1). Patients with a higher burden of comorbidities and who were frail were more likely to be on long term GCs (Table 2). DXA was obtained ≤2 years prior to GC use to ≤3 months after in 42.8%, 72.4%, 56.7%, and 35.6% of all patients, those with low bone mineral density (BMD), those with fracture (other comorbidities range: 24.4%–49.6%) and those with moderate-severe frailty, respectively. Although 57.4% of patients with PMR visited rheumatology within the first 6 months, 36.7% did not in ≤3 years. Rheumatology consultations for PMR were similar regardless of comorbidity or frailty. <h3>Conclusion:</h3> In this observational study, a majority of patients with new onset PMR had or developed comorbidities and frailty over 3 years that may be relative contraindications to long term GC use. Some patients developed these conditions (e.g. fracture) possibly due to GC use and/or other factors. Frailty was higher than previously reported in PMR and community dwelling elderly patients. Despite increased vulnerability to GC toxicity, no substantial difference was observed in GC use in frail patients, possibly due to lack of highly effective alternative treatments. Additional measures are needed to improve BMD screening which was underutilized in PMR patients and rheumatology referral. <h3>REFERENCES:</h3> [1] Sattui SE, et al. <i>Rheumatology (Oxford).</i> 2022. [2] Collart RM, et al. <i>J Am Geriatr Soc</i>. 2012. [3] Halawa OA, et al. <i>Ophthalmology.</i> 2023. [4] Kim DH, et al. <i>J Gerontol A Biol Sci Med Sci.</i> 2018. <h3>Acknowledgements:</h3> The study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Medical writing support for this abstract was provided by Pritha Bhunia, MSc., and Kritika Dhamija, M.S. (Pharm.), of Sanofi. <h3>Disclosure of Interests:</h3> Sebastian E. Sattui Consulting and advisory boards for Sanofi and Amgen (all funds toward research support), Research funding from Bristol Myers Squibb Foundation Robert A. Winn Diversity in Clinical Trials Career Development Award, Research support AstraZeneca and Glaxo Smith Kline (clinical trials), Frank Buttgereit Speaker/honoraria - AbbVie, Sanofi, Pfizer, Consultant - AbbVie, Sanofi, Gruenenthal, and Horizon Therapeutics, Grant/research support - AbbVie, Sanofi, and Horizon Therapeutics, Merav Lidar Speaker/honoraria - Abbvie, Pfizer, Lilly, Novartis, Sanofi, Janssen, GSK, and Astra, Kerri Ford Sanofi, Sanofi, Stefano Fiore Sanofi, Sanofi, Lita Araujo Sanofi, Sanofi, Timothy Beukelman Consulting - UCB, Fenglong Xie: None declared, Jeffrey Curtis Consulting - AstraZeneca, Amgen, AbbVie, Genentech, GSK, Horizon, Janssen, Lilly, Novartis, Pfizer, Sanofi, Scipher, Setpoint, UCB, ongoing, Research grants - AstraZeneca, Amgen, AbbVie, Genentech, GSK, Horizon, Janssen, Lilly, Novartis, Pfizer, Sanofi, Scipher, Setpoint, UCB, ongoing.