Background Glucocorticoids (GLs) are the sole therapeutic approach in Polymyalgia rheumatica (PMR). An undefined proportion of patients respond only to very high doses of GLs and some seem to respond better to methylprednisolone (MPONE) than to prednisone (PN) or vice-versa.
Objectives The aim of this study is to compare MPONE to PN in terms of clinical response and on their effect on HPA axis in patients initiating GL treatment for PMR.
Methods 53 PMR patients were randomized (ratio 1/1) to a fixed daily dose of PN (25 mg) or MPONE (20 mg) and the dose was tapered with a fixed scheme at the time of symptomatic relief. The clinical assessment and the measurement of ESR, CRP, fibrinogen, serum cortisol and ACTH were obtained at fixed time point (two weeks, and 3, 6, 12 months).
Results A significant and comparable reduction of ESR and CRP levels was observed in both groups of patients. A clinical and biochemical remission of PMR was observed in 100% of the patients on MPONE and in 89% of the patients on PN. The mean time to achieve full remission after the first dose was significantly longer for PN (20.3 days) than with MPONE (15.2 days). This difference was mainly driven by 3 patients in whom the remission was achieved after 26-49 days. The mean levels of serum ACTH and cortisol were very similar in both treatment groups as well as the slopes relating equivalent steroid dose.
Conclusions PN and MPONE have a similar therapeutic effect and suppression of the HPA axis in PMR patients. The results of this preliminary study suggest that a delayed response to PN may occur. Further studies are warranted in order to verify whether this might be related with different expression of 11β-HSD activity.
Disclosure of Interest : None declared
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