Influence of Sex on Glucocorticoid Toxicity Profiles in Polymyalgia Rheumatica

Objective

Glucocorticoids (GCs) remain the primary treatment for polymyalgia rheumatica (PMR) but are associated with substantial long‐term toxicity. Although sex‐based differences in GC‐related adverse effects have been suggested, they have not been well studied in PMR.

Methods

We conducted a retrospective cohort study of patients with PMR treated between 2017 and 2024 within a multisite health system. Patients ≥50 years of age with at least two PMR International Classification of Diseases, Tenth Revision, codes and documented GC dosing for ≥75% of days during the first six months of treatment were included. Sex‐based differences in GC toxicity outcomes including incident or worsening hypertension, type 2 diabetes mellitus, and incidence of fragility fractures were evaluated using multivariable regression models adjusted for age, body mass index, treatment site, and baseline type 2 diabetes mellitus.

Results

A total of 1,899 patients met inclusion criteria (915 female patients and 984 male patients; mean age 72.5 years). At one year, the cumulative GC exposure and composite toxicity was not statistically different between sexes. At three years, cumulative GC exposure was higher in female patients (4,419.5 mg prednisone equivalents compared to 4,106.2 mg in male patients, P  = 0.042) as well as daily GC dose ( P  = 0.037). Female patients had a higher incidence of fractures at three years (8.5% vs 3.2%, P ≤ 0.001) and incidence of giant cell arteritis (GCA; 7.6% vs 3.4%, P  < 0.001).

Conclusion

The median cumulative GC exposure in patients with PMR remains high, with higher exposure in female patients. Female patients were more likely to experience fracture and the development of GCA within the same time frame.

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