Methotrexate for treating polymyalgia rheumatica: A meta-analysis of randomized controlled trials

The objective of this study was to evaluate the efficacy and steroid-sparing effect of methotrexate (MTX) in patients with active polymyalgia rheumatica (PMR) undergoing prednisone therapy.

A meta-analysis of randomized controlled trial (RCT) was conducted to compare the efficacy and steroid-sparing effect of MTX with those of placebo in patients with PMR.

Four RCTs (97 patients and 97 controls) were used in this meta-analysis. The remission rate was significantly higher in the MTX group than in the placebo group (odds ratio (OR) = 5.699, 95% confidence interval (CI) = 2.401 - 13.53, p < 0.001). The relapse rate appeared lower in the MTX group than in the placebo group, albeit without significance (OR = 0.377, 95% CI = 0.093 - 1.526, p = 0.171). The cumulative steroid dosage was also significantly lower in the MTX group than in the placebo group (standard mean difference (SMD) = -1.636, 95% CI = -2.864 - 0.407, p = 0.009), which suggested the steroid-sparing role of MTX in PMR therapy. All studies showed the same pattern of SMDs in the cumulative steroid dose, but there was variability in the meta-analysis results for the cumulative steroid dose owing to the disparity in the extent of the effect.

MTX in conjunction with prednisone was more successful than prednisone alone for treating PMR, and the use of MTX was correlated with a decreased average steroid dose.