#3-60E. Prophylaxis in Polymyalgia Rheumatica: The Efficacy Gap between Bisphosphonates and PPIs (Arthritis Rheumatol, 2025)

When initiating glucocorticoids for polymyalgia rheumatica (PMR), clinicians routinely prescribe prophylaxis to mitigate adverse events, yet the real-world efficacy of these interventions remains under-scrutinized. A significant study published in Arthritis & Rheumatology addresses this gap using the UK's CPRD Aurum database, applying a rigorous target trial emulation design to evaluate over 40,000 patients aged 50 and older. The findings present a compelling contrast: bisphosphonates effectively reduced the absolute risk of fragility fractures by approximately 1% over 12 months (NNT 109), whereas prophylactic PPIs or H2RAs demonstrated no statistically significant reduction in serious gastrointestinal ulceration or bleeding. Critically, while the study design mimics a randomized trial, listeners must remain aware of potential residual confounding by indication—where sicker patients preferentially receive prophylaxis—which might obscure the protective effects of PPIs. Nevertheless, for practicing physicians, this data provides a strong evidence base to prioritize bone protection while reconsidering the necessity of reflex gastro-prophylaxis, thereby offering a pathway to reduce pill burden and polypharmacy in this vulnerable elderly population.

Citation: Twohig H, et al. Prescribing of medication to prevent glucocorticoid harms in patients with Polymyalgia Rheumatica: a cross-sectional study and two emulated target trials in the Clinical Practice Research Datalink Aurum. Arthritis & Rheumatology. 2025. DOI: 10.1002/art.70087

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