{
  "abstract": "Objectives To identify glucocorticoid (GC) treatment patterns in patients with polymyalgia rheumatica (PMR) and explore patient profiles that may benefit from GC-sparing interventions.Methods This descriptive study was conducted using an electronic medical record database in Japan. We identified patients with PMR aged ≥50 years who were initiated 5–<30 mg/day of GCs with increased inflammatory markers. Group-based trajectory modelling (GBTM) was used to characterise GC treatment patterns over 52 weeks. We analysed clinical characteristics, including changes in GC doses, longitudinal C-reactive protein levels, immunosuppressant use and GC-related toxicities.Results Among 452 eligible patients with PMR, four treatment trajectories were identified: rapidly-declining (19.0%), low-dose (36.9%), intermediate-dose (32.5%) and high-dose (11.5%). The rapidly declining and low-dose groups had more patients aged ≥80 years and with comorbidities. The median doses at week 52 in the low-dose, intermediate-dose and high-dose groups were 3.0, 4.0 and 7.5 mg/day, respectively. These groups had higher cumulative doses and greater GC-related toxicities compared with the rapidly declining group, which was reduced to 0 mg/day by week 8. The cumulative incidence of immunosuppressant use at week 52 was 6.1%–10.5%, even in the high-dose group.Conclusions GBTM analysis indicates that many patients who do not discontinue GC use within 1 year are exposed to high cumulative GC doses, which are associated with an elevated risk of GC-related toxicities. Our findings highlight the need to reconsider treatment strategies for patients with PMR, including the use of GC-sparing agents.",
  "authors": [
    {
      "affiliations": [
        "Department of Molecular Targeted Therapeutics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka Prefecture, Japan"
      ],
      "name": "Yoshiya Tanaka"
    },
    {
      "affiliations": [
        "Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan"
      ],
      "name": "Toshiya Takahashi"
    },
    {
      "affiliations": [
        "Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan"
      ],
      "name": "Toshiki Fukasawa"
    },
    {
      "affiliations": [
        "Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan"
      ],
      "name": "Shoichiro Inokuchi"
    },
    {
      "affiliations": [
        "Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan"
      ],
      "name": "Hidetoshi Uenaka"
    },
    {
      "affiliations": [
        "Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan"
      ],
      "name": "Akiko Fujita"
    },
    {
      "affiliations": [
        "Real World Evidence Division, Pharmaceutical Business Unit, JMDC Inc, Tokyo, Japan"
      ],
      "name": "Koji Shimamoto"
    },
    {
      "affiliations": [
        "Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan"
      ],
      "name": "Kazuhito Sakamoto"
    }
  ],
  "title": "Trajectory analysis of glucocorticoid treatment highlights issues in the current tapering strategy for polymyalgia rheumatica",
  "uid": "a8d150d7-2338-5c63-8444-b080a0dd525f"
}