| アブストラクト | OBJECTIVES: Polymyalgia rheumatica (PMR) is a common indication for long-term glucocorticoid (GC) treatment. Bone- and gastro-protective 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-/gastro-protective medicine prescribing in people with PMR and evaluate its impact on adverse GC outcomes using a target trial approach. METHODS: A sample of >40,000 individuals aged >/=50 years, with a coded PMR diagnosis from January 2010-March 2022, prescribed GCs within 21 days of first PMR diagnosis code, was constructed in CPRD Aurum. Prescriptions were defined as prevalent (pre-PMR diagnosis), incident (at diagnosis), or late (post-diagnosis, still GC-treated), reported stratified by age/gender/deprivation. A target-trial approach assessed the effect of: a) bisphosphonates on fragility fractures and b) proton-pump inhibitors/H2-receptor antagonists (PPIs/H2RAs) on gastrointestinal (GI) ulceration/bleeding. Treatment effect, adjusted for confounders, was modelled using targeted maximum likelihood estimation. RESULTS: 67.2% were co-prescribed bisphosphonates and 78.6% PPIs/H2RAs. Males and those in more deprived areas were less likely to receive bisphosphonates. 1.40% (95%CI 1.10%,1.70%) of those prescribed vs 2.32% (2.12%,2.52%) of those not prescribed bisphosphonates for 12 months experienced a fracture (risk difference 0.92% points [0.56%,1.27%], NNT 109). Prescribing gastro-protective medications was not associated with serious GI events. CONCLUSION: Rates 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. |
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| ジャーナル名 | Arthritis & rheumatology (Hoboken, N.J.) |
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| Pubmed追加日 | 2026/2/11 |
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| 投稿者 | Twohig, Helen; Jenkinson, David; Bailey, James; Hider, Samantha; Scott, Ian C; Muller, Sara |
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| 組織名 | School of Medicine, David Weatherall building, Keele University, Keele,;Staffordshire, ST5 5BG, United Kingdom.;Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership;University NHS Foundation Trust, High Lane, Burslem, Staffordshire, ST6 7AG,;United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/41668463/ |
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