POS0422 CHARACTERISTICS ASSOCIATED WITH LONG-TERM GLUCOCORTICOIDS USE IN PATIENTS WITH NEW ONSET POLYMYALGIA RHEUMATICA
Authors: A.B. Dua, A. Rubbert-Roth, K. Ford, S. Fiore, L. Araujo, T. Beukelman, F. Xie, J.R. Curtis
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Polymyalgia Rheumatica (PMR) is a common inflammatory rheumatic condition in people aged ≥50 years with incidence peaking at 70–80 years. PMR is primarily treated with glucocorticoids (GC) with guideline recommended treatment duration of 36–48 weeks without a flare or 40–52 weeks with a single flare.[1] However, it is estimated that 77%, 51%, and 25% of PMR patients remain on GC at 1, 2, and 5 years, respectively.[2] Extended GC therapy can increase the risk of GC-related toxicity, particularly in this elderly population. Thus, early recognition of patients who may require GC treatment for &gt;1 year will help identify patients at risk of GC toxicity who could benefit from GC sparing therapies. Few studies have evaluated factors that could be indicators of patients likely to require extended GC therapy.[3,4] <h3>Objectives:</h3> To identify characteristics at 6 months in new onset PMR patients associated with extended GC use beyond 1 year. <h3>Methods:</h3> This was an exploratory analysis of an inception cohort of PMR patients identified from fee-for-service Medicare claims from 10/01/2016 to 12/31/2020.[5] Patients included had no history of PMR or giant cell arteritis, were ≥50 years, had ≥1 inpatient or ≥2 outpatient claims for PMR (ICD-10-CM M35.3) ≥30 days and &lt;365 days apart. They initiated GC (prednisone equivalent) 7.5–25 mg/day ≤30 days after 1st inpatient code or from 1st outpatient to ≤30 days after 2nd outpatient code, had GC dose ≥200 mg in first ≤30 days and ≥4 months continuous GC use. Continuous enrollment ≥1 year prior to first diagnosis date was required. Patients with other systemic rheumatic disease, active malignancy treatment, multiple sclerosis, solid organ transplant, or prescription for conventional synthetic immunomodulatory drugs [csIM (methotrexate [MTX], leflunomide, azathioprine)] or interleukin-6 receptor inhibitors, ≤1 year prior to first (inpatient) or second (outpatient) PMR diagnosis to 6 months after GC initiation (baseline period), were also excluded (GC cohort). A supplemental analysis evaluated patients who met other criteria and received a csIM ≤6 months from GC initiation (csIM cohort). The primary outcome was comparison of characteristics (demographic, clinical, and healthcare resource utilization) at 6 months between patients who were on GC vs. off GC (&gt;60-day gap) at 1 year. Comorbidities were defined using diagnosis, procedure, or drug codes. Frailty was assessed by a validated claims-based frailty index[6] and defined using a published threshold.[7] <h3>Results:</h3> A total of 4,748 patients were included in the GC cohort and 318 in the csIM cohort. MTX was the most common csIM [200/318 (62.9%)]. Of patients in the GC cohort and csIM cohort, 3,038 (64.0%) and 183 (57.5%) were <i>on</i> GC at 1 year, respectively. In both GC and csIM cohorts, significantly more patients <i>on</i> GC vs. <i>off</i> GC at 1 year were on GC dose ≥5 mg at 6 months. Patients <i>on</i> GC vs. <i>off</i> GC at 1 year also had significantly higher cumulative GC use at 6 months in both cohorts (<b>Table 1</b>). In the GC cohort, demographic characteristics and presence of comorbidities or frailty at 6 months, were not associated with GC use at 1 year while in the csIM cohort, age, year GC was initiated, initial GC dose, and glaucoma were significantly associated with GC use at 1 year (<b>Tables 1,2</b>). A sensitivity analysis including patients who initiated MTX within 6 months found 55.5% (111/200) of patients were <i>on</i> GC at 1 year and MTX use was significantly associated with GC use at 1 year: fewer patients <i>on</i> GC vs. <i>off</i> GC at 1 year had received MTX within 6 months [111/3149 (3.5%) vs 89/1799 (4.9%); p=0.015]. <h3>Conclusion:</h3> More than half of PMR patients remained on GC beyond 1 year. Evaluation of GC dose at 6 months may be useful to identify patients who may benefit from GC sparing therapy. <h3>REFERENCES:</h3> [1] Dejaco C et al. Arthritis Rheumatol 2015, 67:2569–80. [2] Floris A et al. Clin Rheumatol 2022, 41:19–31. [3] Perricone C et al. Clin Exp Med 2023, 23:3391–7. [4] Birra D et al. Clin Exp Rheum 2020, 38:436–41. [5] Curtis J, et al. Arthritis Rheumatol 2023, 75. [6] Kim DH et al. J Gerontol A Biol Sci Med Sci 2018, 73:980–7. [7] Halawa OA, et al, Ophthalmology 2023, 130: 646-54. <h3>Acknowledgements:</h3> This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Medical writing support for this abstract was provided by Kavita Garg, PhD, CMPP, of Sanofi. <h3>Disclosure of Interests:</h3> Anisha B Dua Consultant: AbbVie, Amgen, Astra Zeneca, GSK, Sandoz, Sanofi, Andrea Rubbert-Roth Honoraria for consultation and lectures from AbbVie, BMS, Gilead, Lilly, Pfizer, Roche, Sanofi, UCB, Kerri Ford Employee of Sanofi and may hold stock and/or stock options in the company, Stefano Fiore Employee of Sanofi and may hold stock and/or stock options in the company, Lita Araujo Employee of Sanofi and may hold stock and/or stock options in the company, Timothy Beukelman Consultant: UCB, Fenglong Xie: None declared, Jeffrey R Curtis Consulting and research grants from AstraZeneca, Amgen, AbbVie, Bendcare, Genentech, GSK, Horizon, Janssen, Lilly, Novartis, Pfizer, Sanofi, Scipher, Setpoint, and UCB.