Study: Most Patients with PMR Aren’t Getting Steroid-Sparing Agents in First 2 Years

A minority of patients with polymyalgia rheumatica (PMR) who were new to rheumatology practice were prescribed steroid-sparing agents through two years of follow-up. This is according to a large, U.S.-based cohort study, published in Arthritis Care & Research, which also found that nearly two-thirds of the patients remained on glucocorticoids beyond one year.¹

“Our study shows current contemporary practice, indicating that glucocorticoid-sparing agents are still used in a minority of patients despite the need for prolonged use of glucocorticoids,” says Sebastian E. Sattui, MD, MS, an assistant professor of medicine and director of the UPMC Vasculitis Center at the University of Pittsburgh School of Medicine. “Although these decisions in clinical practice are guided by a shared decision-making process (e.g., balancing low-dose glucocorticoids vs. methotrexate or similar agent), it possibly also reflects the lack of evidence to better guide clinicians on the use of glucocorticoid-sparing agents with regard to value, timing and balancing risks and benefits.”

Background

Dr. Sattui

Historically, the treatment of patients with PMR—one of the most common systemic rheumatic diseases in older adults—relied on the long-term use of glucocorticoids, but treatment relapses occur in up to half of the patients. Recent studies showed the efficacy of steroid-sparing agents for PMR, including rituximab and the interleukin (IL) 6 inhibitors tocilizumab and sarilumab.^2-4 In February 2023, the U.S. Food & Drug Administration (FDA) approved sarilumab (Kevzara) for the treatment of adults with glucocorticoid-resistant or relapsing PMR.⁵

“Our study is quite timely given the recent publication of trials using biologic drugs for the treatment of PMR and even more so with the recent FDA approval of sarilumab for the treatment of refractory/relapsing PMR,” says Dr. Sattui. “Data included in our analysis was up to 2022, so less likely to be affected by the publication of these new trials and even more so the FDA approval.”

Dr. Sattui explains, “Our goal was to better describe the current treatment patterns of individuals with PMR under rheumatology care. We focused on trying to understand these patients who are being seen by rheumatologists, as well as the duration of glucocorticoid treatment and current use—as well as factors—of glucocorticoid-sparing agents.”

Cohort Study

A total of 26,102 patients with PMR were identified in the ACR Rheumatology Informatics System for Effectiveness (RISE) registry from 2016 to 2022, of which 16,703 patients were new to rheumatology practice and presumed to have new-onset PMR.¹ To assess treatment patterns over time, the majority of the analysis of this electronic health record data focused on the new patients. The researchers looked at the use of glucocorticoids and immunomodulatory drugs employed as steroid-sparing agents. They aimed to identify factors associated with prolonged glucocorticoid use and the persistent use of steroid-sparing agents beyond one year.