Alessandro Giollo1,2, Maurizio Rossini3,4, Francesco Bettili3,4, Francesco Ghellere3,4, Elena Fracassi3,4, Luca Idolazzi3,4, Davide Gatti3,4, Ombretta Viapiana3,4. 1. From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy. alessandrogiollo@gmail.com. 2. A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona. alessandrogiollo@gmail.com. 3. From the Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy. 4. A. Giollo, MD, Rheumatology Unit, Department of Medicine, University of Verona; M. Rossini, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; F. Bettili, MD, Rheumatology Unit, Department of Medicine, University of Verona; F. Ghellere, MD, Rheumatology Unit, Department of Medicine, University of Verona; E. Fracassi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; L. Idolazzi, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; D. Gatti, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona; O. Viapiana, MD, PhD, Rheumatology Unit, Department of Medicine, University of Verona.
Abstract
OBJECTIVE: The duration of treatment with glucocorticoids (GC) in polymyalgia rheumatica (PMR) is often longterm. Amino bisphosphonates (N-BP) are used in PMR for the prevention of GC-induced osteoporosis, but they coulsd also have immunomodulatory properties. Whether they can be effective as an adjuvant treatment in PMR is unknown. We aimed to establish whether the use of N-BP in our PMR cohort may be associated with GC discontinuation. METHODS: We conducted a retrospective review of all patients diagnosed with PMR recorded in our electronic medical notes. Cox regression analyses were used to examine the association between the use of N-BP and discontinuation of GC. RESULTS: Data were retrieved for 385 patients (mean age 71 ± 10 yrs, 64% females, mean initial prednisone dose 19 ± 9 mg/day). The median followup time was 38 months (range 9-57); more than 60% of patients were exposed to N-BP. GC were discontinued in 47% of patients after a median time of 20 months (range 14-27), but subsequently restarted in 39%. Overall, 276/385 patients (72%) were actively treated at their last available evaluation (mean prednisone dose 4.9 ± 5.5 mg/day), while 123/205 (60%) were still receiving GC after 24 months of followup. The use of N-BP was associated with the discontinuation of GC (adjusted HR 0.66, 95% CI 0.50-0.88), independent of age, initial GC dose, and osteoporosis. CONCLUSION: Unlike current guidelines, longterm treatment with GC is often necessary. These preliminary data suggest that N-BP may be involved in the management of PMR.
OBJECTIVE: The duration of treatment with glucocorticoids (GC) in polymyalgia rheumatica (PMR) is often longterm. Amino bisphosphonates (N-BP) are used in PMR for the prevention of GC-induced osteoporosis, but they coulsd also have immunomodulatory properties. Whether they can be effective as an adjuvant treatment in PMR is unknown. We aimed to establish whether the use of N-BP in our PMR cohort may be associated with GC discontinuation. METHODS: We conducted a retrospective review of all patients diagnosed with PMR recorded in our electronic medical notes. Cox regression analyses were used to examine the association between the use of N-BP and discontinuation of GC. RESULTS: Data were retrieved for 385 patients (mean age 71 ± 10 yrs, 64% females, mean initial prednisone dose 19 ± 9 mg/day). The median followup time was 38 months (range 9-57); more than 60% of patients were exposed to N-BP. GC were discontinued in 47% of patients after a median time of 20 months (range 14-27), but subsequently restarted in 39%. Overall, 276/385 patients (72%) were actively treated at their last available evaluation (mean prednisone dose 4.9 ± 5.5 mg/day), while 123/205 (60%) were still receiving GC after 24 months of followup. The use of N-BP was associated with the discontinuation of GC (adjusted HR 0.66, 95% CI 0.50-0.88), independent of age, initial GC dose, and osteoporosis. CONCLUSION: Unlike current guidelines, longterm treatment with GC is often necessary. These preliminary data suggest that N-BP may be involved in the management of PMR.