Prescribing of Medication to Prevent Glucocorticoid Harms in Patients With Polymyalgia Rheumatica: A Cross-Sectional Study and Two Emulated Target Trials in the Clinical Practice Research Datalink Aurum.

objectivePolymyalgia rheumatica (PMR) is a common indication for long-term glucocorticoid (GC) treatment. Bone-protective and gastroprotective medications are recommended for those at high risk of adverse events from GCs, but no trials have evaluated their effectiveness in PMR. We describe bone-protective and gastroprotective medicine prescribing in people with PMR and evaluate its impact on adverse GC outcomes using a target trial approach.

methodsA sample of >40,000 individuals aged ≥50 years with a coded PMR diagnosis from January 2010 to March 2022 who were prescribed GCs within 21 days of the first PMR diagnosis code was constructed in the Clinical Practice Research Datalink Aurum. Prescriptions were defined as prevalent (pre-PMR diagnosis), incident (at diagnosis), or late (post diagnosis, still GC-treated), reported stratified by age, sex, and deprivation. A target trial approach assessed the effects of (1) bisphosphonates on fragility fractures and (2) proton-pump inhibitors/H

results67.2% participants were coprescribed bisphosphonates and 78.6% were coprescribed PPIs/H

conclusionRates of prescribing to mitigate GC harms are higher than previously reported. Bisphosphonates are associated with approximately one less fragility fracture per year for every 100 people treated. Gastro-prophylaxis is not associated with reduced risk of GI ulceration/bleeding, suggesting potential to reduce prescribing for this indication.