Comparable Rates of Glucocorticoid-Associated Adverse Events in Patients With Polymyalgia Rheumatica and Comorbidities in the General Population

Abstract

Objective: To investigate the use of glucocorticoids (GCs) and related adverse events (AEs) in a long-term, geographically defined cohort of patients with polymyalgia rheumatica (PMR).

Methods: Using a population-based inception cohort, details of GC therapy were abstracted from medical records of all patients diagnosed with PMR in 2000-2014. Age- and sex-matched comparators without PMR were identified from the same underlying population. Cumulative and daily dosage of GC, rate of disease relapse, occurrence of GC-related AEs, and rate of GC discontinuation were analyzed.

Results: The study included 359 patients with PMR and 359 comparators. The median time to taper below 5 mg/day for 6 months was 1.44 years (95% confidence interval [95% CI] 1.36-1.62), while the median time to permanent discontinuation was 5.95 years (95% CI 3.37-8.88). The mean ± SD cumulative dose of GC at 2 and 5 years was 4.0 ± 3.5 grams and 6.3 ± 9.8 grams, respectively. The mean ± SD daily dose of GC at 2 and 5 years was 6.1 ± 7.6 mg/day and 7.2 ± 9.5 mg/day, respectively. There were no differences in rates of AEs between patients with PMR and comparators for diabetes mellitus, hypertension, hyperlipidemia, or hip, vertebral, or Colles fractures (P > 0.2 for all). Cataracts were more common in patients with PMR than comparators (hazard ratio 1.72 [95% CI 1.23-2.41]).

Conclusion: Relapse rates in PMR are highest in the early stages of therapy. Despite often protracted therapy, with the exception of cataracts, the rates of studied morbidities linked to GC are not more common in PMR than comparators.

Figure 1.

Patients’ times to dose reduction and relapse. yr = year; PMR = polymyalgia rheumatica.