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

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.

• Authors: Marco A Cimmino, Massimiliano Parodi, Carlomaurizio Montecucco, Roberto Caporali
• Journal: BMC musculoskeletal disorders (BMC Musculoskelet Disord) Vol. 12 Issue 1 Pg. 94 (May 14 2011) ISSN: 1471-2474 [Electronic] England
• PMID: 21569559 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Glucocorticoids
• C-Reactive Protein
• Prednisone

Topics

• Administration, Oral
• Aged
• Analysis of Variance
• Biomarkers (blood)
• Blood Sedimentation
• Body Weight
• C-Reactive Protein (metabolism)
• Drug Dosage Calculations
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Male
• Middle Aged
• Polymyalgia Rheumatica (diagnosis, drug therapy, physiopathology)
• Prednisone (administration & dosage)
• Regression Analysis
• Remission Induction
• Severity of Illness Index
• Time Factors
• Treatment Outcome