Evaluating an alternative oral regimen for the treatment of polymyalgia rheumatica

It is often recommended that patients with polymyalgia rheumatica (PMR) be started with 15 mg/day or more of prednisone for at least 1 month, and then continually tapered until they stop taking prednisone. A much shorter time at 15 mg/day and a prolonged period at 5 mg/day may be as efficacious and lead to shorter treatment courses. I had 22 patients meeting criteria for PMR and started with a regimen of 15 mg/day for 3 days, 10 mg/day for 7 days, 5 mg/day for 1 year, and then tapered at 1 mg/day/month. I had 15 patients rapidly tapered to 5 mg, whereas for 7 a rapid taper failed. Among 14 patients followed to the end of treatment, 10 patients successfully stopped taking prednisone without a relapse (mean prednisone dose 1864 mg at 415 days) and 4 additional patients relapsed but were tapered off prednisone later (mean = 2365 mg at 525 days for all 16 patients). The ability to be tapered off prednisone was not related to the ability to be rapidly tapered to 5 mg/day (p = NS). One patients is taking 3 mg/day at 53 months, and 1 required hydroxychloroquine therapy to be tapered to 5 mg/day. There was 6 patients lost to follow-up. These results suggest that a rapid taper of prednisone dose from 15 to 5 mg is possible in many patients with PMR and that a subsequent year of 5 mg/day before further tapering may result in a lower total dose of prednisone than with many previously recommended regimens.