Long term treatment of polymyalgia rheumatica with deflazacort.

Abstract

Deflazacort was administered at a mean starting dose of 21 8 mg/day with a range of 6-60 mg depending on severity of disease. The Results PATIENTSThe mean age of the 40 patients (24 women/ 16 men) was 70 7 years (range 50-91 years). Patients were referred 4-6 months after the onset of PMR on average (range 1-14 months).Twenty seven patients were allowed to continue treatment with NSAIDs at low doses. Of these, 15 received NSAIDs for less than three months and 12 for 9 7 months in average. The dose of NSAIDs in these 12 patients was constant throughout the study. FOLLOW UPTwo patients were lost to follow up on the first and third month. In the remaining 38 patients, the treatment lasted a mean of 18-9 months (range 9-48 months). Of the 23 patients with remission, seven required deflazacort for less than one year, and 20 for less than two years (fig 1). In these patients, the mean follow up after discontinuation of deflazacort was 9 9 months (range 1-33 months). The mean daily dose of deflazacort was 11-4 mg (range 2-5-32-2 mg) and the cumulative dose ranged between 0 9 g and 27 g (mean 6-6 g).Twenty three of 38 patients (60-5%) had no exacerbations; 13 patients had one exacerbation, 331 on 9 May 2018 by guest. Protected by copyright.

Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica

“…One study each reported a lower discontinuation rate of GCs after 2 years (n=50, LoB 4/8),14 a longer duration of GC therapy (n=183, LoB 3/8),32 a higher risk of developing GCA (n=176, LoB 5/8)25 and a higher cumulative GC dose (n=80, LoB 4/8) 37. Additionally, GC side effects were generally more common among women than men (three studies, total n=196, LoB 2–4/8) 31 36 37…”

“…A single study, for example, showed a higher relapse rate in women than in men,37 whereas eight other studies found no such association 18 20 24 34 41 51 52 57. On the other hand, women appeared to have a longer duration of treatment,14 32 higher cumulative GC doses37 and more GC-related side effects 31 36 37. Whether female patients benefit from a closer (than standard) clinical monitoring, a lower initial GC dose and a lower threshold for using MTX has to be clarified by future clinical studies.…”

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

“…Baseline factors that were associated in low to moderate quality studies with a higher relapse rate and/or prolonged therapy in PMR studies were: female sex (24,26), high ESR (.40 mm/hour) (26)(27)(28)(29)(30)(31) and peripheral inflammatory arthritis (32). A number of equally low to moderate quality studies, however, failed to demonstrate an association between these factors and relapse/prolonged therapy (27)(28)(29)(30)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). C. Consideration of specialist referral, particularly in case of atypical presentation (such as peripheral inflammatory arthritis, systemic symptoms, low inflammatory markers, age ,60 years), experience of or high risk of therapy-related side effects, PMR refractory to GC therapy, and/or relapses/prolonged therapy.…”

The role of the general practitioner and the out-of-hospital public rheumatologist in the diagnosis and follow-up of patients with polymyalgia rheumatica

“…A too rapid tapering is another common attitude that favours relapses. Italian GPs sometimes use deflazacort, the efficacy of which seems to be similar to that of prednisone (28)(29)(30). However, the benefit of deflazacort in terms of side effects is unclear, it is not reimbursed by the Italian National Health System, and is more expensive than prednisone.…”