Amino bisphosphonates tied to glucocorticoid discontinuation in polymyalgia rheumatica
Long-term treatment with glucocorticoids (GC) is necessary in polymyalgia rheumatica (PMR), but preliminary data of a study suggests that use of amino bisphosphonates (N-BP) correlates with GC discontinuation in the management of PMR.
The authors retrieved data for 385 patients (mean age, 71 years; 64 percent women; mean initial prednisone dose, 19 mg/day). Median follow-up period was 38 months (range, 9–57). Of the patients, >60 percent were exposed to N-BP.
After a median of 20 months (range, 14–27), 47 percent of patients discontinued use of GC, but 39 percent subsequently restarted. Of the 385 patients, 276 (72 percent) were actively treated at their last available evaluation (mean prednisone dose, 4.9 mg/day), while 123 of 205 (60 percent) patients still received GC after 24 months of follow-up.
An association existed between N-BP use and GC discontinuation (adjusted hazard ratio, 0.66; 95 percent CI, 0.50–0.88), independent of age, initial GC dose and osteoporosis.
“The duration of treatment with GC in PMR is often long-term,” the authors said. “N-BPs are used in PMR for the prevention of GC-induced osteoporosis, but they could also have immunomodulatory properties.”
This study sought to establish whether N-BP use in a PMR cohort might be associated with GC discontinuation. The authors retrospectively reviewed all patients diagnosed with PMR recorded in electronic medical notes. They used Cox regression analyses to examine the relationship between N-BP use and discontinuation of GC.