P023 National care of patients with Polymyalgia Rheumatica: Audit of steroid usage from UK GP data - a cause for concern?

Abstract

Abstract Background/Aims Polymyalgia rheumatica (PMR) is the most common autoimmune musculoskeletal condition in the developed world. Current BSR guidelines recommend glucocorticoid treatment for one to two years and give suggested taper regimens. The project examines national primary care data to assess the level of adherence to current guidelines, and the proportion of patients at risk from the deleterious effects of prolonged steroid exposure. Methods The ECLIPSE databased covers over 25m patients across 2400 general practices in England and provides insights for enhanced clinical pathway management and to support patient safety in primary care. Routinely recorded diagnoses from primary care data are updated daily, along with administrative prescribing data. Using standardised nationally agreed disease coding frameworks, all diagnoses of PMR were retrieved from the live patient population of 25.4m individuals registered with general practices across England. Primary care diagnosis data for patients with a new diagnosis of PMR recorded in primary care on or after 01/01/2016 were linked with prescribing data from the same time period and followed to 10/10/2022. From the current BSR guidelines the following thresholds were taken to represent above recommended cumulative glucocorticoid exposure: 0-6 months >2100mg, 7 to 12 months >1400mg, 13 to 18 months >910mg and 19 to 24 months >910mg. Finally total numbers of those still prescribed glucocorticoids past 60 months was taken as to represent those who had become steroid-dependent. Results Over the observation period of 6.8 years there were 95,862 people diagnosed with PMR from the UK national data, of whom 22,677 were diagnosed in the East of England and 5,315 from the Norfolk and Waveney Integrated Care System. The prevalence was 0.99%, 1.00% and 1.5% for those aged older than 50 years across the three areas respectively consistent with published disease estimates. There was considerable number of individuals with PMR prescribed glucocorticoids above the recommend levels (see Table 1). Conclusion There is significant departure from the suggested PMR tapering regimens which may be due to frequency of relapse, inadequate treatment response or inadequate guideline implementation. Strategies to reduce glucocorticoid exposure in this older co-morbid population are required urgently. Disclosure P. Saha: None. J. Brown: None. A. MacGregor: None. C. Aldus: None. M. Yates: None.