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Multicenter Study
. 2011 May 14;12(1):94.
doi: 10.1186/1471-2474-12-94.

The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity

Marco A Cimmino  1 , Massimiliano Parodi, Carlomaurizio Montecucco, Roberto Caporali
Affiliations
Multicenter Study

The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity

Marco A Cimmino et al. BMC Musculoskelet Disord. .

Abstract

Background: the mainstay of treatment of polymyalgia rheumatica (PMR) is oral glucocorticoids, but randomized controlled trials of treatment are lacking. As a result, there is no evidence from controlled studies on the efficacy of different initial doses or glucocorticoid tapering. The aim of this study is to test if 12.5 mg prednisone/day is an adequate starting dose in PMR and to evaluate clinical predictors of drug response.

Methods: 60 consecutive PMR patients were treated with a starting dose of 12,5 mg/day prednisone. Clinical, laboratory, and, in a subset of 25 patients, ultrasonographic features were recorded as possible predictors of response to prednisone. Remission was defined as disappearance of at least 75% of the signs and symptoms of PMR and normalization of ESR and CRP within the first month, a scenario allowing steroid tapering.

Results: 47/60 (78.3%) patients responded to 12.5 mg of prednisone after a mean interval of 6.6±5.2 days. In univariate analysis, body weight and gender discriminated the two groups. In multivariate analysis, the only factor predicting a good response was low weight (p=0.004); the higher response rate observed in women was explained by their lower weight. The mean prednisone dose per kg in the responders was 0.19±0.03 mg in comparison with 0.16±0.03 mg for non responders (p=0.007).

Conclusions: 12.5 mg prednisone is a sufficient starting dose in ¾ of PMR patients. The main factor driving response to prednisone in PMR was weight, a finding that could help in the clinical care of PMR patients and in designing prospective studies of treatment.

Trial registration: ClinicalTrials.gov: NCT01169597.

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Figures

Figure 1
Figure 1
Interval between initiation of treatment and clinical remission.
Figure 2
Figure 2
Erythrocyte sedimentation rate (ESR) at baseline and at the week 1 and 4 control visits in the whole group of patients, in responders and non-responders. There was a significant difference by repeated measures ANOVA between responders and non-responders (p = 0.017) and within groups (p < 0.001).
Figure 3
Figure 3
C-reactive protein (CRP) at baseline and at the week 1 and 4 control visits in the whole group of patients, in responders and non-responders. There was a significant difference by repeated measures ANOVA between responders and non-responders (p = 0.044) and within groups (p < 0.001).
See this image and copyright information in PMC

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