E009 An audit looking into bisphosphonate co-prescription and compliance in patients with giant cell arteritis

Abstract

Abstract Background/Aims The treatment of giant cell arteritis includes glucocorticoid use to reduce inflammation. There are known drawbacks of long-term glucocorticoid use, including osteopenia and osteoporosis. The British Society for Rheumatology giant cell arteritis guidelines recommend that we should consider appropriate pharmacological bone protection at the time of presentation to counteract this. Glucocorticoid toxicity risks increases with both dosage and duration of steroid use. To reduce steroid burden, we consider introduction of the steroid sparing agents such as tocilizumab and methotrexate. This audit was to look into whether we were locally achieving bone protection consideration and to whether steroid sparing agents were helping in terms of compliance of bisphosphonates. Methods We retrospectively looked at the clinical letters of the patients locally diagnosed with giant cell arteritis in the previous 3 years to ascertain whether there was documentation of decisions around starting bisphosphonates at the time of diagnosis and whether the patients tolerated bisphosphonate therapy for the recommended duration. Patients were classified into 3 groups, as to whether their treatment was glucocorticoids with tocilizumab (TOC), glucocorticoids with methotrexate (MTX) or glucocorticoid monotherapy (MONO). Results 49 Patients were identified. 3 of these patients were excluded for various reasons. 17 were in the TOC group, 11 in the MTX group, and 18 in the MONO group. Documentation of consideration of bisphosphonates at diagnosis was 94% in TOC, 91% in MTX and 100% in MONO. Overall this was 96%. Compliance of bisphosphonate therapy for the recommended duration was 88% in TOC, 90% in MTX and 86% in MONO. Overall compliance was 88%. There was no statistically significant difference between the steroid sparing groups and the monotherapy group both in terms of consideration of initiation of bisphosphonate treatment and compliance of bisphosphonate treatment, with p values of 0.52 and 0.8 respectively. Conclusion Overall, we found that locally there was good consideration of bisphosphonate therapy at diagnosis and that compliance remained good throughout treatment. This can help reduce the side effect profile of glucocorticoid toxicity. Although, there was no statistically significant difference in our study of concordance of bisphosphonates between the two groups, steroid sparing agents are useful in our arsenal at reducing the risks of glucocorticoid toxicity. Disclosure A.A. Bolger: None. L. Hutton: None.