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

BMC Musculoskelet Disord. 2011 May 14;12(1):94. doi: 10.1186/1471-2474-12-94.

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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
  • Polymyalgia Rheumatica / drug therapy*
  • Polymyalgia Rheumatica / physiopathology
  • Prednisone / administration & dosage*
  • Regression Analysis
  • Remission Induction
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Glucocorticoids
  • C-Reactive Protein
  • Prednisone

Associated data

  • ClinicalTrials.gov/NCT01169597