The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity.
Author(s): Cimmino MA, Parodi M, Montecucco C, Caporali R
Affiliation(s): Clinica Reumatologica, Dipartimento di Medicina Interna, Universita di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy. cimmino@unige.it
Publication date & source: 2011-05-14, BMC Musculoskelet Disord., 12(1):94.
Publication type: Multicenter Study; Research Support, Non-U.S. Gov't
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 (3/4) 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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