{"title":"糖皮质激素治疗与多发性风湿痛患者的临床疗效:使用常规健康数据的队列研究","authors":"Yoshiya Tanaka , Shinichi Tanaka , Toshiki Fukasawa , Shoichiro Inokuchi , Hidetoshi Uenaka , Takeshi Kimura , Toshiya Takahashi , Naoto Kato","doi":"10.1016/j.jbspin.2023.105680","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>We aimed to describe the following in patients with polymyalgia rheumatica (PMR): (1) real-world glucocorticoid (GC) therapy, (2) improvement in inflammatory parameters associated with disease activity (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and (3) incidence of GC-related adverse events (AEs).</p></div><div><h3>Methods</h3><p>A cohort study was conducted using a Japanese electronic medical records database. We included newly diagnosed PMR patients aged<!--> <!-->≥<!--> <!-->50<!--> <!-->years with baseline CRP levels<!--> <!-->≥<!--> <!-->10<!--> <!-->mg/L and/or ESR<!--> <!-->><!--> <!-->30<!--> <!-->mm/h and an initial GC dose of<!--> <!-->≥<!--> <!-->5<!--> <!-->mg/day. The outcomes were GC dose, inflammatory parameters, and GC-related AEs.</p></div><div><h3>Results</h3><p>A total of 373 PMR patients (mean age, 77.3 years) were analyzed. The median initial GC dose was 15.0<!--> <!-->mg/day, which gradually decreased to 3.5<!--> <!-->mg/day by week 52. The median cumulative GC dose at week 52 was 2455.0<!--> <!-->mg. The median CRP level on day 0 was 64.3<!--> <!-->mg/L, which decreased during weeks 4–52 (1.4–3.2<!--> <!-->mg/L). At week 52, 39.0% of patients had a CRP level<!--> <!-->><!--> <!-->3.0<!--> <!-->mg/L. The cumulative incidence of GC-related AEs at week 52 was 49.0% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 2.9% for glaucoma, and 4.3% for serious infection. The incidence of osteoporosis and diabetes increased with the GC dose.</p></div><div><h3>Conclusion</h3><p>The incidence of GC-related AEs was associated with the GC dose in PMR patients. Further research is required to identify treatment strategies that can effectively control PMR disease activity while minimizing GC use.</p></div>","PeriodicalId":54902,"journal":{"name":"Joint Bone Spine","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1297319X23001598/pdfft?md5=a8e69bc31ac4c2c1389618a81c760ec5&pid=1-s2.0-S1297319X23001598-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Glucocorticoid treatment and clinical outcomes in patients with polymyalgia rheumatica: A cohort study using routinely collected health data\",\"authors\":\"Yoshiya Tanaka , Shinichi Tanaka , Toshiki Fukasawa , Shoichiro Inokuchi , Hidetoshi Uenaka , Takeshi Kimura , Toshiya Takahashi , Naoto Kato\",\"doi\":\"10.1016/j.jbspin.2023.105680\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>We aimed to describe the following in patients with polymyalgia rheumatica (PMR): (1) real-world glucocorticoid (GC) therapy, (2) improvement in inflammatory parameters associated with disease activity (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and (3) incidence of GC-related adverse events (AEs).</p></div><div><h3>Methods</h3><p>A cohort study was conducted using a Japanese electronic medical records database. We included newly diagnosed PMR patients aged<!--> <!-->≥<!--> <!-->50<!--> <!-->years with baseline CRP levels<!--> <!-->≥<!--> <!-->10<!--> <!-->mg/L and/or ESR<!--> <!-->><!--> <!-->30<!--> <!-->mm/h and an initial GC dose of<!--> <!-->≥<!--> <!-->5<!--> <!-->mg/day. The outcomes were GC dose, inflammatory parameters, and GC-related AEs.</p></div><div><h3>Results</h3><p>A total of 373 PMR patients (mean age, 77.3 years) were analyzed. The median initial GC dose was 15.0<!--> <!-->mg/day, which gradually decreased to 3.5<!--> <!-->mg/day by week 52. The median cumulative GC dose at week 52 was 2455.0<!--> <!-->mg. The median CRP level on day 0 was 64.3<!--> <!-->mg/L, which decreased during weeks 4–52 (1.4–3.2<!--> <!-->mg/L). At week 52, 39.0% of patients had a CRP level<!--> <!-->><!--> <!-->3.0<!--> <!-->mg/L. The cumulative incidence of GC-related AEs at week 52 was 49.0% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 2.9% for glaucoma, and 4.3% for serious infection. The incidence of osteoporosis and diabetes increased with the GC dose.</p></div><div><h3>Conclusion</h3><p>The incidence of GC-related AEs was associated with the GC dose in PMR patients. Further research is required to identify treatment strategies that can effectively control PMR disease activity while minimizing GC use.</p></div>\",\"PeriodicalId\":54902,\"journal\":{\"name\":\"Joint Bone Spine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2023-12-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1297319X23001598/pdfft?md5=a8e69bc31ac4c2c1389618a81c760ec5&pid=1-s2.0-S1297319X23001598-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Bone Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1297319X23001598\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Bone Spine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1297319X23001598","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Glucocorticoid treatment and clinical outcomes in patients with polymyalgia rheumatica: A cohort study using routinely collected health data
Objective
We aimed to describe the following in patients with polymyalgia rheumatica (PMR): (1) real-world glucocorticoid (GC) therapy, (2) improvement in inflammatory parameters associated with disease activity (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and (3) incidence of GC-related adverse events (AEs).
Methods
A cohort study was conducted using a Japanese electronic medical records database. We included newly diagnosed PMR patients aged ≥ 50 years with baseline CRP levels ≥ 10 mg/L and/or ESR > 30 mm/h and an initial GC dose of ≥ 5 mg/day. The outcomes were GC dose, inflammatory parameters, and GC-related AEs.
Results
A total of 373 PMR patients (mean age, 77.3 years) were analyzed. The median initial GC dose was 15.0 mg/day, which gradually decreased to 3.5 mg/day by week 52. The median cumulative GC dose at week 52 was 2455.0 mg. The median CRP level on day 0 was 64.3 mg/L, which decreased during weeks 4–52 (1.4–3.2 mg/L). At week 52, 39.0% of patients had a CRP level > 3.0 mg/L. The cumulative incidence of GC-related AEs at week 52 was 49.0% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 2.9% for glaucoma, and 4.3% for serious infection. The incidence of osteoporosis and diabetes increased with the GC dose.
Conclusion
The incidence of GC-related AEs was associated with the GC dose in PMR patients. Further research is required to identify treatment strategies that can effectively control PMR disease activity while minimizing GC use.
期刊介绍:
Bimonthly e-only international journal, Joint Bone Spine publishes in English original research articles and all the latest advances that deal with disorders affecting the joints, bones, and spine and, more generally, the entire field of rheumatology.
All submitted manuscripts to the journal are subjected to rigorous peer review by international experts: under no circumstances does the journal guarantee publication before the editorial board makes its final decision. (Surgical techniques and work focusing specifically on orthopedic surgery are not within the scope of the journal.)Joint Bone Spine is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.