POS0280 EFFECTIVENESS OF METHOTREXATE AND LEFLUNOMIDE AS CORTICOID-SPARING DRUGS IN PATIENTS WITH POLYMYALGIA RHEUMATICA
Authors: J. P. Vinicki, A. Cusa, D. Domingo, J. L. Velasco Zamora, S. J. Magri, J. A. Brigante, M. Schmid, P. Andrea Avila, N. Zamora, L. Sorrentino, A. Rodriguez, M. Linarez, C. Pisoni, C. Costi, G. F. Rodriguez Gil, M. A. Spinetto, U. V. Paris, N. A. Perrotta, M. D. R. Maliandi, O. Rillo, C. Pena, J. Got, J. Cavallasca, M. Machado Escobar, C. Iturralde, M. V. Martire, R. Tessel, K. N. Saravia, G. S. Alarcón
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The need for glucocorticoid sparing drugs (GCSD) remains an important issue and is an unmet need in the treatment of polymyalgia rheumatica (PMR). <h3>Objectives:</h3> We therefore assessed the effectiveness and safety of methotrexate (MTX) and of leflunomide (LEF) in daily clinical practice in PMR patients from Argentina. <h3>Methods:</h3> A multicenter and observational study (medical records review) of PMR patients seen between 2007 and 2023, who had at least three months of follow-up after starting a GCSD, either MTX or LEF, was performed. Results are expressed as medians and interquartile ranges [25th–75th (IQR)] for continuous variables and percentages for categorical ones. The two treatments groups were compared using χ2 test for categorical variables, Mann-Whitney U test for continuous variables and the log-rank test for time-to-event data. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression. In all cases, a p value &lt;0.05 was considered statistically significant. <h3>Results:</h3> One-hundred and eighty-six patients (79% female) with a median age of 72 years (IQR, 65–77 years) were included. One-hundred and forty-three patients (77%) were prescribed MTX (15, IQR 10-15) and 43 (23%) LEF (20 mg, fixed dose). Flare-ups (relapses and recurrences) occurred in 17 patients (9%) and were comparable between both groups. Persistent GCSD intake was observed in 145 patients (78%). Glucocorticoid (GC) withdrawal was achieved in 67 of these 145 patients (46%) and this occurred more frequently in the LEF group (p = 0.001). Furthermore, time until prednisone discontinuation was shorter in the LEF-treated patients (4.7 months, IQR 3-20 on LEF versus 31.8 months, IQR 10-82 on MTX, p = 0.000). Remission was found more frequently in the LEF group (p = 0.003). In the multivariate Abstract Preview analysis, the probability of remission was higher with LEF therapy (adjusted odds ratio [OR] 2.96, 95% CI = 1.29-6.78, p = 0.004). <h3>Conclusion:</h3> This is the first study to demonstrate the clinical effectiveness of LEF and even its superiority in achieving remission when compared to MTX as GCSD in PMR patients. Further research is needed to support these findings. <h3>REFERENCES:</h3> [1] Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982 Nov;97(5):672-80. [2] Kyle V, Hazleman BL. Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimens in the first two months. Ann Rheum Dis. 1989 Aug;48(8):658-61. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>