PMR & Glucocorticoids
Analysis from the ACR RISE registry
By Sebastian E. Sattui, MD, MS
Why was this study done? Polymyalgia rheumatica (PMR) is one of the most common rheumatic diseases. However, critical knowledge gaps regarding the use of both glucocorticoid and glucocorticoid-sparing treatments in PMR exist. The goal of this study was to describe current treatment practices, including the use of glucocorticoids and glucocorticoid-sparing agents, in a national cohort of individuals with PMR under rheumatology care.
What were the study methods? Patients with PMR were identified in the ACR Rheumatology Informatics System for Effectiveness (RISE) registry from 2016–22. Use of glucocorticoids and immunomodulatory antirheumatic medications used as glucocorticoid-sparing agents were examined during a 24-month follow-up. The main analysis focused on a subgroup of patients new to rheumatology practices, the majority with presumed new-onset PMR. Multivariate logistic regressions were performed to identify factors associated with persistent glucocorticoid and glucocorticoid-sparing agent use at 12–24 months.
What were the key findings? In the main analysis, 16,703 patients with PMR were included. At 12–24-month follow-up, 63.8% of patients remained on glucocorticoids, while only 39% of patients were receiving a glucocorticoid-sparing agent. Methotrexate (19.5%) was the most frequent choice of glucocorticoid-sparing agent. Female sex, higher comorbidity count and use of glucocorticoid-sparing agent at 24 months were associated with persistent glucocorticoid use; higher comorbidity count and obesity (BMI ≥35 kg/m2) were associated with use of glucocorticoid-sparing agents at 12–24 months.
What were the main conclusions? Despite the need for prolonged glucocorticcoid use, a minority of patients with PMR under rheumatology care received a glucocorticoid-sparing agent at 12–24 months. Further information with regard to value, timing and balancing the risks and benefits is needed.
What are the implications for patients? Prolonged glucocorticoid use is frequent in patients with PMR. Specific characteristics were associated with prolonged use of glucocorticoids and could identify patients for whom glucocorticoid-sparing therapies should be considered.
What are the implications for clinicians? Our study is timely given increased data on the use of biologic drugs for the treatment of PMR, including the recent U.S. Food & Drug Administration approval of sarilumab for treatment of refractory/relapsing PMR. Use of glucocorticoid-sparing agents should be considered in patients with persistent disease and glucocorticoid requirement.
The study: Sattui SE, Xie F, Clinton C, et al. Treatment of polymyalgia rheumatica by rheumatology providers: Analysis from the ACR Rheumatology RISE registry. Arthritis Care Res (Hoboken). 2023 Aug 10. doi:10.1002/acr.25.216. Online ahead of print.
