scholarly journals Steroid-Sparing Effect of Tocilizumab and Methotrexate in Patients with Polymyalgia Rheumatica: A Retrospective Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2948
Author(s):  
Keisuke Izumi ◽  
Okinori Murata ◽  
Misako Higashida-Konishi ◽  
Yuko Kaneko ◽  
Hisaji Oshima ◽  
...  
Keyword(s):  
Polymyalgia Rheumatica ◽  
Retrospective Cohort ◽  
Inflammatory Disorder ◽  
Discontinuation Rate ◽  
Future Studies ◽  
Prednisolone Dose ◽  
Baseline Characteristics ◽  
Sparing Effect ◽  
Steroid Sparing

Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness in the shoulders, hips, and proximal limbs; it usually affects elderly patients. The effectiveness of methotrexate and tocilizumab in PMR treatment has not been extensively studied. Thus, we aimed to assess the steroid-sparing effect of tocilizumab and methotrexate in PMR in clinical practice. Consecutive patients with PMR in our hospitals, who were included in our retrospective cohort, were reviewed between 2005 and 2015 and divided into the following groups according to their treatments: prednisolone or none (prednisolone group), methotrexate ± prednisolone (methotrexate group), or tocilizumab ± prednisolone (tocilizumab group). The prednisolone dose at the last follow-up was compared. A total of 227 patients with an average age of 74 years were enrolled. No difference in baseline characteristics was found among the three groups. The prednisolone dose at the last follow-up was lower (0 vs. 3.0 vs. 3.5 mg/day, p < 0.001) and the prednisolone discontinuation rate was higher (80.0% vs. 28.3% vs. 18.8%, p < 0.0001) in the tocilizumab group than in the prednisolone and methotrexate groups. This study suggested that tocilizumab has a steroid-sparing effect in PMR. Tocilizumab can be an option in the management of PMR. Future studies are warranted to confirm our findings.

scholarly journals POS0338 STEROID-SPARING EFFECT OF ANAKINRA IN GIANT-CELL ARTERITIS: A CASE SERIES WITH CLINICAL, BIOLOGICAL AND ICONOGRAPHIC LONG-TERM ASSESSMENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 397.1-397
Author(s):  
S. Deshayes ◽  
K. Ly ◽  
V. Rieu ◽  
G. Maigné ◽  
N. M. Silva ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Interleukin 1 ◽  
Oral Prednisone ◽  
Large Vessel ◽  
Daily Dose ◽  
Sparing Effect ◽  
Steroid Sparing

Background:The treatment of giant cell arteritis (GCA) relies on corticosteroids but is burdened by a high rate of relapses and adverse effects. Anti-interleukin-6 treatments show a clear benefit with a significant steroid-sparing effect, but late relapses occur after treatment discontinuation. In addition to interleukin-6, interleukin-1 also appears to play a significant role in GCA pathophysiology.Objectives:We report herein the efficacy of anakinra, an interleukin-1 receptor antagonist, in 6 GCA patients exhibiting corticosteroid dependence or resistance, specifically analyzing the outcome of aortitis in 4 of them, and including the long-term follow-up of 2 previously described patients (1).Methods:This retrospective study analyzed the cases of all GCA patients treated with anakinra from the French Study Group for Large Vessel Vasculitis.Patients had to satisfy the following two criteria to be enrolled in this retrospective study. First, their diagnosis of GCA should be based on the fulfillment of at least 3 criteria of the American College of Rheumatology (ACR) for GCA or on the satisfaction of 2 of these criteria along with the demonstration of LVI on imaging. Second, patients should have received anakinra because of corticosteroid dependence or resistance.Corticosteroid dependence was defined as ≥2 relapses or the combination of 2 of the following criteria: a daily dose of oral prednisone >20 mg/day (or 0.3 mg/kg) at 6 months; a daily dose of oral prednisone >10 mg/day (or 0.2 mg/kg) at 12 months; and/or a treatment maintained >24 months because of a relapsing disease course. Corticosteroid resistance was defined as persistent increased inflammatory parameters at month 3 despite a steroid dosage over 0.5 mg/kg.Results:After a median duration of anakinra therapy of 19 [18–32] months, all 6 patients exhibited complete clinical and biological remission. Among the 4 patients with large-vessel involvement, 2 had a disappearance of aortitis under anakinra, and 2 showed a decrease in vascular uptake. After a median follow-up of 56 [48–63] months, corticosteroids were discontinued in 4 patients, and corticosteroid dosage could be decreased to 5 mg/day in 2 patients. One patient relapsed 13 months after anakinra introduction in the context of increasing the daily anakinra injection interval to every 48 hours. Three patients experienced transient injection-site reactions, and 1 patient had pneumonia.Figure 1.Steroid dosages before and after the introduction of anakinra in 6 patients with giant-cell arteritis and corticosteroid dependence or resistance. The black arrow indicates the time of anakinra introduction.Conclusion:In this short series, anakinra appears to be an efficient and safe steroid-sparing agent in refractory GCA, with a possible beneficial effect on large-vessel involvement.References:[1]Ly K-H, Stirnemann J, Liozon E, Michel M, Fain O, Fauchais A-L. Interleukin-1 blockade in refractory giant cell arteritis. Joint Bone Spine 2014;81:76–8.Disclosure of Interests:Samuel Deshayes: None declared, Kim LY: None declared, Virginie Rieu: None declared, Gwénola Maigné: None declared, Nicolas Martin Silva: None declared, Alain Manrique: None declared, Jacques Monteil: None declared, Hubert de Boysson Speakers bureau: Roche-Chugai, Grant/research support from: Roche-Chugai, Achille Aouba Grant/research support from: SOBI

Abstract 17114: CHA 2 DS 2 -VASc Score is a Poor Predictor of Thromboembolic Events in Heart Failure Patients With and Without Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Harold Rivner ◽  
George R Marzouka ◽  
Fei Tang ◽  
Jeffrey J Goldberger
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Predictive Models ◽  
Retrospective Cohort ◽  
Predictive Ability ◽  
Thromboembolic Events ◽  
Poor Predictor ◽  
Baseline Characteristics ◽  
Event Rates

Introduction: Recent evidence suggests that the CHA 2 DS 2 -VASc score could be used to predict thromboembolic events (TE) (both CVA and noncerebral thromboembolism) in heart failure (HF) patients without atrial fibrillation (AF). This non-American cohort study had several limitations. We performed a retrospective analysis using the national Veteran Affairs database to externally validate the findings. Hypothesis: The CHA 2 DS 2 -VASc score can be used equally to predict TE in HF patients with or without AF. Methods: A retrospective cohort of the national Veteran’s Affairs database was used to identify HF patients discharged between 2002-2010. Rates for TE were calculated at both 1 and 5 years. C-statistics were calculated to test the performance of CHA 2 DS 2 -VASc in predicting the rate of TE in HF patients with and without AF. Patients who developed AF during the follow-up period (crossovers) and those on anticoagulation where excluded. Negative predictive value was calculated using cutoff value of 1. Results: A total of 77,601 patients were included in this analysis: 51,667 without AF and 15,630 with AF. 10,294 crossover patients were excluded. Baseline characteristics and medications are listed in Table 1. Event rates are reported in Table 2—there is a small trend towards higher incidence with increasing score in both groups. However, C-statistics were overall poor but similar for predicting TE in both groups (Table 3) Conclusion: Our analysis suggests CHA 2 DS 2 -VASc is a poor predictive model for TE in HF with or without AF. We found that previous conclusions regarding the predictive ability of CHA 2 DS 2 -VASc are not generalizable to our large American cohort. Like previously published studies, we show that the predictive ability of CHA 2 DS 2 -VASc was similar in both HF patients with or without AF, despite excluding patient receiving anticoagulation. This suggests that AF may not be the main predictor of TE in HF patients. There is a need for better predictive models for TE in HF.

Impact of rituximab on anthropometric indices among childhood steroid-dependent nephrotic syndromes

2020 ◽  
pp. archdischild-2019-318019
Author(s):  
Rajiv Sinha ◽  
Sushmita Banerjee ◽  
Anwesha Mukherjee ◽  
Shakil Akhtar ◽  
Subal Pradhan
Keyword(s):  
Body Mass Index ◽  
Short Stature ◽  
Body Mass ◽  
Retrospective Review ◽  
Anthropometric Parameters ◽  
Anthropometric Indices ◽  
Steroid Dependent ◽  
Sparing Effect ◽  
Steroid Sparing

BackgroundThere is scarcity of data on impact of rituximab on anthropometrical parameters (weight, height and body mass index i.e. BMI SD score (SDS)) among children with steroid-dependent nephrotic syndromes (SDNS).MethodsMulticentre retrospective review.Results102 children with SDNS (male: 63%; n=64), median age 7 (IQR: 4.3–9.6) years, received a total of 217 rituximab infusions (total 110 cycles). At median follow-up of 2.1 (IQR: 1.3–2.8) years, 58 (57%) children were off steroids and a significant fall in steroid threshold for relapse was noted (median 0.6; IQR 0.4–0.9 to median 0.3; IQR 0.12 - 0.5 mg/kg/alternate day, p=0.005). Anthropometric parameters (BMI SDS: 0.92±1.8 to 0.25±1.47, p=0.003; weight SDS: 0.20±1.6 to −0.11±1.3, p=0.01; and height SDS: −0.93±1.88 to −0.45±1.54, p=0.04) as well as obesity (38% to 20%, p=0.003) and short stature (11% to 3%, p=0.02) improved. Results remained significant even when analysis was restricted to children ≤12 years (n=88), (BMI SDS: 0.97±1.98 to 0.25±1.5, p=0.001; weight SDS: 0.33±1.6 to 0.02±1.2, p=0.01; and height SDS: −0.67±1.84 to −0.186±1.42, p=0.001).ConclusionsUse of rituximab resulted in significant steroid sparing effect with an improvement in both growth and obesity parameters.

scholarly journals Imaging in polymyalgia rheumatica

Reumatismo ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 51 ◽  
Author(s):  
N. Possemato ◽  
C. Salvarani ◽  
N. Pipitone
Keyword(s):  
Polymyalgia Rheumatica ◽  
Morning Stiffness ◽  
Imaging Techniques ◽  
Review Article ◽  
Inflammatory Disorder ◽  
Chronic Inflammatory Disorder ◽  
Pet Ct ◽  
Ct And Mri

Polymyalgia rheumatica (PMR) is a chronic, inflammatory disorder of unknown cause clinically characterized by pain and prolonged morning stiffness affecting the shoulders and often the pelvic girdle and neck. Imaging has substantially contributed to defining PMR as a disease mainly involving extra-articular structures. This review article analyses the role of the different imaging techniques in the diagnosis and follow-up of patients with PMR with particular emphasis on the role of ultrasound, PET/CT and MRI.

scholarly journals P588 Steroid sparing effect of adalimumab in cortisone–depended ulcerative colitis patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S539-S539
Author(s):  
M Sina ◽  
E Pengili ◽  
X Pemaj ◽  
D Osmanaj ◽  
I Bibolli ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Tertiary Hospital ◽  
Average Dose ◽  
Biologic Treatment ◽  
Steroid Dose ◽  
Steroid Dependent ◽  
Sparing Effect ◽  
Steroid Sparing

Abstract Background Corticosteroids are indicated for induction of remission in moderate to severe ulcerative colitis (UC) patients. However, due to their adverse effects associated with long-term use, steroids are not indicated as a maintenance therapy. The aim of this study was to assess the steroid sparing effect of adalimumab (ADA) in steroid-dependent UC patients. Methods This is a prospective study carried out at a tertiary hospital center in Albania from 2016–2020, including consecutive moderate-to-severe UC patients. All patients received biologic therapy with subcutaneous ADA 160/80mg at weeks 0/2 followed by 40mg every 2 weeks. We evaluated the steroid-sparing effect of ADA measuring the number of steroid–free patients and the average steroid dose at baseline before initiating biologic treatment and at week 8, 24, 52, 104, 156. Clinical remission was defined as total Mayo score ≤ 2 points. Results We enrolled 26 UC patients, mean age 47.3 ± 16.1 (24–85) years, 55.6% were females. The average disease duration before starting ADA was 7.3 ± 7.0 years (range 1–33); 44.4% had pancolitis and 55.6% left side colitis. 8(29.6%) patients were on combination therapy with azathioprine. 17/26 (65.4%) patients were taking prednisone at the time of the first ADA injection with an average dose of 17.7mg. The number of steroid-free patients at week 8, 24, 52, 104 and 156 was 12/26 (46.2%), 16/26 (61.5%), 15/21 (71.4%), 11/14 (78.6%), 8/9 (88.9%) respectively. At the end of the follow-up (week 156), the proportion of steroid free patient was significantly higher than at baseline [88.9% (8/9) vs 34.6% (7/26), p=0.005]. The reduction of the average dose of prednisone (8.8 mg, 4 mg, 6.8mg, 3.8mg and 3,8mg at week 8, 24, 52, 104 and 156 respectively), was also statistically significant (p&lt;0.01). Clinical remission rates were 7.7% (2/26) at week 8, 47.6% (10/21) at week 52, 42.9% (6/14) at week 104 and 44.4 % (4/9) at week 156. Conclusion In our cohort, ADA administration to moderate–to severe UC significantly reduced the steroid dose and the proportion of patients taking cortisone during 3 years follow-up.

scholarly journals FRI0475 STEROID SPARING AGENTS IN POLYMYALGIA RHEUMATICA: A SYSTEMATIC REVIEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 834.2-835
Author(s):  
S. Banerjee ◽  
K. Chaudhuri ◽  
A. Desai ◽  
M. Krishna ◽  
N. Gullick
Keyword(s):  
Adverse Events ◽  
Polymyalgia Rheumatica ◽  
Classification Criteria ◽  
Risk Of Bias ◽  
List Type ◽  
High Quality ◽  
Level 1 ◽  
Sparing Effect ◽  
Level 2 ◽  
Steroid Sparing

Background:Polymyalgia rheumatica (PMR) is the commonest chronic inflammatory musculoskeletal disease of the elderly. The mainstay of treatment for PMR is long term systemic glucocorticoid (GC), which is associated with significant systemic toxicity. There is a need for steroid sparing drugs in PMR to reduce GC cumulative dose and GC induced adverse effects.(1)Objectives:To evaluate the role of steroid sparing agents in PMR.Primary outcomes:1.Steroid sparing effect of the intervention, measured by difference in cumulative glucocorticoid dose2.Percentage of patients in remission.Secondary outcomes:1. Mean reduction of CRP/ESR2. Adverse event/toxicity the drugs being compared—measured as number of patients with adverse events in the compared groups3. Percentage of patients with relapse during study period4. MortalityMethods:Electronic databases including Medline, Embase and Cochrane databases (CENTRAL) were searched since inception for prospective randomized control trials comparing disease modifying anti rheumatic drugs (DMARDs) and biologics with systemic GC in PMR, published in English with more than 20 patients and a minimum study duration of 24 weeks. As different classification criteria for PMR exist, studies were included if they used any accepted classification criteria for PMR. Case series, case reports, retrospective, non-randomized trials, abstracts, systematic reviews and non English language trials were not included. Patients with Giant cell arteritis (GCA) were excluded. Risk of bias and quality was assessed using the Cochrane tool.The studies were assessed for cumulative GC dose, proportion of patients in remission, proportion of patients with relapse, reduction in inflammatory markers, adverse events and mortality.Results:5 studies were selected for final review-- 3 studies involving Methotrexate, one study on azathioprine, one on Infliximab. The study on Azathioprine had high risk of bias, small sample size and low quality (Level 2 evidence) with high attrition rate but it revealed reduction of daily prednisolone with Azathioprine. A high quality RCT (Level 1) did not confirm a steroid sparing effect with Infliximab vs placebo, and there was no significant difference between relapse or remission rate. Methotrexate studies showed conflicting results: one high quality RCT (Level 1) and one low quality RCT (Level 2) on Methotrexate revealed statistically significant steroid sparing effect, however the remaining study did not demonstrate between Methotrexate and placebo. Two methotrexate studies assessed the risk of relapse, with conflicting results (relapses 73% placebo vs 47% methotrexate; or no difference).Methotrexate was not associated with increased adverse effects in any of the studies. Azathioprine was associated with significant adverse events resulting in high attrition.A meta analysis was not performed for methotrexate as the studies were heterogenous.Conclusion:There is a lack of evidence regarding DMARDs and biologics in PMR. Methotrexate is an effective steroid sparing agent, and is not associated with increased adverse events. Azathioprine may be effective but is associated with significant adverse events. Infliximab is not an effective steroid sparing agent in PMR. More high quality RCTs are needed to study the efficacy of steroid sparing agents.References:[1]Bhaskar Dasgupta, Frances A. Borg, Nada Hassan, Kevin Barraclough, Brian Bourke, Joan Fulcher, Jane Hollywood, Andrew Hutchings, Valerie Kyle, Jennifer Nott, Michael Power, Ash Samanta, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guidelines for the management of polymyalgia rheumatica,Rheumatology, Volume 49, Issue 1, January 2010, Pages 186–190Disclosure of Interests:None declared

scholarly journals Efficacy, Safety and Steroid-sparing Effect of Topical Cyclosporine A 0.05% for Vernal Keratoconjunctivitis in Indian Children

2019 ◽  
Author(s):  
Arkendu Chatterjee ◽  
Sabyasachi Bandyopadhyay ◽  
Samir Kumar Bandyopadhyay
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Cyclosporine A ◽  
Controlled Study ◽  
Vernal Keratoconjunctivitis ◽  
Indian Children ◽  
Steroid Dependent ◽  
Sparing Effect ◽  
Steroid Sparing

Purpose: To evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC). Methods: A prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each followup visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out. Results: Significant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P < 0.0001 in all follow-up visits) and sign (P < 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 ± 0.5 and 3.79 ± 0.4 in Cs A and placebo groups, respectively (P < 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group. Conclusion: Topical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.

Patient-Reported Treatment Satisfaction with Dabigatran versus Warfarin in Patients with Non-Valvular Atrial Fibrillation in China

2018 ◽  
Vol 118 (10) ◽  
pp. 1815-1822 ◽  
Author(s):  
Yan-Ping Geng ◽  
Di-Hui Lan ◽  
Nian Liu ◽  
Xin Du ◽  
Danni Zheng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Satisfaction ◽  
Insurance Coverage ◽  
Critical Issue ◽  
Discontinuation Rate ◽  
Patient Reported ◽  
Baseline Characteristics ◽  
Adjusted Logistic Regression

Background Anti-coagulant therapy satisfaction for patients with atrial fibrillation is a critical issue, which impacts on their treatment adherence and clinical outcomes. The disadvantages of long-term warfarin treatment are well-described, and novel oral anti-coagulants have become an alternative option. Materials and Methods We compared patient-reported treatment satisfaction with dabigatran versus warfarin in non-valvular atrial fibrillation (NVAF) patients in China. Treatment satisfaction was assessed using the Anti-Clot Treatment Scale (ACTS) questionnaire, which included a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale. Results Among 834 patients, 246 patients (29.5%) were taking dabigatran and the others were on warfarin. Propensity score matching was employed to identify 182 patient pairs with balanced baseline characteristics. The global ACTS Burdens score and the global ACTS Benefits score were comparable between the dabigatran and warfarin groups (44.86 ± 3.95 vs. 44.28 ± 3.51, p = 0.423; 11.49 ± 2.92 vs. 11.42 ± 3.03, p = 0.194, respectively). The monthly cost of dabigatran was significantly higher compared with that of warfarin due to a lack of insurance coverage (USD 176.78 ± 9.15 vs. USD 2.49 ± 0.76, p = 0.000). The discontinuation rate of dabigatran was significantly higher than warfarin at the 6-month follow-up (33.5% vs. 19.2%, p = 0.003). Adjusted logistic regression showed that dabigatran was associated with a significant greater odds of non-persistence (odds ratio: 2.13, 95% confidence interval: 1.27–3.59, p = 0.004). Conclusion Dabigatran therapy in patients with NVAF in China associated with no improvement in satisfaction and a higher discontinuation rate compared with warfarin therapy largely due to increased economic burden.

scholarly journals Discontinuation of anticoagulation and its associated factors in atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Sanchez Bustamante ◽  
J.L Navarro Estrada ◽  
E Rossi ◽  
A.L Gamarra ◽  
G.F Maid ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Vitamin K ◽  
Vitamin K Antagonist ◽  
Discontinuation Rate ◽  
Factors Associated ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Antagonist Group

Abstract Background/Introduction Oral anticoagulation has been shown to reduce the incidence of embolic events associated with atrial fibrillation, however the discontinuation of these drugs observed in clinical trials may not be representative of the real-world setting due to the inclusion of selected populations. Purpose The objective of the study was to compare whether there is a difference in the incidence rate of discontinuation between vitamin K antagonists and direct anticoagulants and to evaluate the factors associated with non-adherence in patients newly diagnosed with atrial fibrillation. Methods This was a prospective cohort study. Adult patients (age &gt;18 years) who had newly started anticoagulation therapy for atrial fibrillation or atrial flutter were enrolled. Patients with previous oral anticoagulation, mechanical prosthetic heart valves or creatinine clearance less than 30 mL/min were excluded. The follow-up period was 12 months. As the treatment allocation was not randomized, a propensity score weighting was performed considering baseline characteristics potentially associated with exposure and outcome. Factors associated with anticoagulant discontinuation were evaluated using a weighted Cox model. Results A total of 379 patients were included (mean age 78±9 years, 58% females). The median follow-up was 362 days (IQR 347–370). Loss to follow-up was 1%. The anticoagulation discontinuation rate was 24.6% in the direct anticoagulant group and 15.6% in the vitamin K antagonist group. A weighted model of time to discontinuation of anticoagulation treatment showed a crude HR of 1.40 (95% CI 0.79–2.48) for the direct anticoagulant therapy group compared to the vitamin K antagonist group, and a model adjusted for age, type of atrial fibrillation, radiofrequency ablation, bleeding, number of chronic drugs, and cardiology consultations during follow-up showed an adjusted HR of 1.26 (95% CI 0.75–2.12). The main reason for discontinuation of anticoagulation was high risk of bleeding in the vitamin K antagonist group and performance of a radiofrequency ablation procedure in the direct anticoagulant group. There was no statistically significant difference in the discontinuation rate between both groups when the baseline characteristics of the patients were considered. Conclusion(s) There was no statistically significant difference in the discontinuation rate between both groups when the baseline characteristics of the patients were considered. The study showed that the discontinuation of anticoagulants in atrial fibrillation in our setting was not associated with the type of drug used, the age of patients, or the type of arrhythmia. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boehringer Ingelheim Figure 1

scholarly journals FRI0527 THE EFFECT OF A NURSE-LED PREDNISOLONE TAPERING REGIME IN POLYMYALGIA RHEUMATICA: A RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 863.2-863
Author(s):  
C. Mork ◽  
M. Yde Matthiesen ◽  
M. Callsen ◽  
K. Keller
Keyword(s):  
Cohort Study ◽  
Usual Care ◽  
Retrospective Cohort Study ◽  
Polymyalgia Rheumatica ◽  
Retrospective Cohort ◽  
Standard Care ◽  
Care Group ◽  
Standard Care Group ◽  
Prednisolone Dose ◽  
Prednisolone Treatment

Background:The cornerstone treatment of polymyalgia rheumatic (PMR) is prednisolone, which has several side effects such as osteoporosis and type 2 diabetes [1]. Therefore, the duration of prednisolone treatment should be as short as possible. Previous studies indicate that only 10-30% has discontinued prednisolone after 1 year and approximately 50% after 2 years [2].Objectives:To investigate the efficacy of a nurse-led prednisolone tapering regime in patients with PMR compared to usual care.Methods:The study is a single center retrospective cohort study with a 2-year follow-up. Prednisolone dose was evaluated after 1 and 2 years.A nurse-led PMR clinic was introduced June 1st, 2015 and patients diagnosed until June 7th, 2017 were included. Patients were diagnosed by a physician, and subsequently managed by nurses according to a specific protocol, with prednisolone tapering from 15 mg to discontinuation after 52 weeks. Regularly blood tests and telephone interviews were performed and a rheumatologist was involved if deemed necessary.Patients diagnosed with PMR between June 1st, 2012 and June 1st, 2015 served as controls. They received standard care by a rheumatologist.The Danish guidelines for managing PMR remained unchanged throughout the study period.The study population was identified by searching the electronic patient journal for the PMR diagnosis. Data collection was performed by four experienced reumatologists. Data were obtained from the Electronic Patient Journal of Central Denmark Region and recorded in the RedCap database.Results:Five hundred and seventy patients were screened. Patients not diagnosed with PMR, with simultaneously giant cell arteritis, with relapse of known PMR, or prednisolone treatment for more than 4 weeks prior to the diagnosis were excluded. Sixty eight patients received standard care and 107 nurse-led care. There was no statistical difference between groups regarding reason for exclusion.At baseline there was no difference between patients receiving standard care and nurse-led care regarding gender, mean age (70.7 years vs. 72.2 years), clinical findings, symptoms, level of C-reactive protein (43.4 mg/L vs. 39.7 mg/L), anti-citrullinated protein antibody and reumatoid factor status. Median (IQR) prednisolone starting dose in the standard care group was 15 mg (15-25) vs. 15 mg (15-15) in the nurse-led care group (p=0.008).After 1 year 29.4% of patients receiving standard care had discontinued prednisolone vs. 35.5% receiving nurse-led care (p=0.403). Median (IQR) prednisolone dose after 1 year was 3.75 mg (0-5) in the standard care group and 1.25 mg (0-3.75) in nurse-led care group (p=0.004). After 2 years 60.3% of patients receiving standard had discontinued prednisolone vs. 82.2% receiving nurse-led care (p=0.001). Median (IQR) prednisolone dose after 2 years was 0 mg (0-2.5) in the standard care group and 0 mg (0-0) in the nurse-led care group (p=0.004). There was no difference between groups regarding relapse of PMR and initiation of MTX treatment in either year 1 or 2.Conclusion:A tight and systematic approach to prednisolone tapering in PMR is more effective than usual care. The results should be confirmed in a prospective setting.References:[1] Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997; 40(10):1873-8.[2] Muratore F, Pipitone N, Hunder GG, Salvarani C. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis. Clin Exp Rheumatol 2013; 31(4 Suppl 78):S86-92.Disclosure of Interests:None declared

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