Almost 1 in 2 people with polymyalgia rheumatica (PMR) receive more than 2 years of glucocorticoid (GC) therapy following diagnosis, despite guidelines recommending that dose tapering is initiated within 4 to 8 weeks of introduction of GC treatment.
That is the finding of research conducted by the Arthritis UK Primary Care Centre at Keele University using data from the Clinical Practice Research Datalink.
Of the 5,364,005 people included in the study, 42,125 people had an incident diagnosis of PMR during the study period (1990-2016). Overall, the incidence of PMR during the study period was 95.9 per 100,000 person-years (95% CI, 94.9-96.8). After increasing until 2002, the incidence of PMR stabilised in later years. In 2015, the incidence was 91.1 (95% CI, 86.7-95.6).
However, the study also found that a significant proportion of patients are being treated with GCs for much longer than guidelines suggest. The median time taken for patients to stop continuous GC therapy was 1.31 years (interquartile range [IQR], 0.65-2.6). When total GC treatment time was reviewed, median duration increased to 1.93 years (IQR, 0.95-4.03), meaning around 25% of patients received more than 4 years of therapy.
The median first and average daily doses of GC received (in milligrams of prednisolone equivalent) were 15 mg (IQR, 8-21) and 6 mg (IQR, 4-9), respectively. However, 16.9% patients received greater than 10 mg per day.
The authors say the study provides evidence which is “contrary to previously held norms that cure will be achieved within 2 years.”
“Early identification of patients who are likely to be subject to prolonged GC therapy is a priority area for future research. These patients could then be prioritised for referral to secondary care for consideration of GC-sparing agents,” they conclude.
