# Oral Steroid Pulse Therapy for Polymyalgia Rheumatica

## TL;DR

This study evaluates a new oral steroid treatment for polymyalgia rheumatica, showing it can quickly reduce symptoms and allow some patients to stop steroids without relapse.

## Contribution

The study introduces and evaluates an intermittent oral steroid pulse therapy regimen for PMR in a clinical setting.

## Key findings

- Both 0.4P and 0.8P regimens significantly reduced CRP and ESR levels after the first course.
- Twenty-one patients successfully stopped steroids without relapse during a median follow-up of 27 months.
- No severe adverse events were reported with the oral-P regimen.

## Abstract

Objectives: A new regimen of oral steroid pulse therapy (oral-P), involving intermittent administration of a sufficient oral steroid dose, was adopted for the treatment of polymyalgia rheumatica (PMR). A retrospective evaluation of oral-P in a clinical setting was conducted.

Materials and methods: The medical records of PMR patients, diagnosed according to the American College of Rheumatology/European League Against Rheumatism criteria and treated with oral prednisone (P) between April 2015 and July 2020, were reviewed. One course of oral-P consisted of prednisolone at 0.4 mg/kg/day for three consecutive days, followed by 0.1 mg/kg/day for 11 days (0.4P), or 0.8 mg/kg/day followed by 0.2 mg/kg/day (0.8P). After three or five courses, the dose was tapered. The attending physician selected the treatment regimen. Serum C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESRs) were monitored. The duration of disease prior to oral-P initiation, follow-up duration after its withdrawal, and any adverse events were assessed.

Results: Thirty-four patients (22 women and 12 men, aged 66-86 years; 15 on 0.4P and 19 on 0.8P; 11/4 on three/five courses with 0.4P, and 13/6 with 0.8P) were included. Prior to oral-P initiation, CRP levels and ESRs were significantly higher in the 0.8P group than in the 0.4P group (CRP: 8.93 (4.83-12.0) vs. 4.96 (4.15-6.31) mg/dL; ESR: 113.5 (92.75-129) vs. 84 (66-95.5) mm/h). Although the disease duration before oral-P initiation was longer in the 0.8P group, the difference was not statistically significant. After the first course, both CRP levels and ESRs decreased significantly in both groups, with no significant differences observed between the groups in subsequent courses. Twenty-one patients were successfully withdrawn from steroid therapy without relapse during a follow-up period of 27 (14-49) months. The remaining 13 patients were still undergoing dose tapering at their last visit, with a median dose of 3 (2-6) mg/day. No severe adverse events were reported.

Conclusion: Oral-P appears to be a promising treatment regimen for PMR, providing rapid symptom relief and enabling eventual steroid withdrawal.