Study: Very Low-Dose Glucocorticoids Safe for Early Active Rheumatoid Arthritis

The results of a new study supported the good safety profile of low-dose glucocorticoids (GC) for the treatment of early active rheumatoid arthritis (RA). The analysis included 602 patients with early active RA from the early arthritis Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort. Patients were stratified into 2 groups: 386 patients with GC treatment (64.1%) who received low-dose prednisone, and 216 patients (35.9%) without GC treatment. The mean duration of GC treatment was 1057±876 days, and the mean dose was 3.1±2.9 mg per day. Incidences of death, severe infection, fracture, and cardiovascular disease, including myocardial ischaemia, cerebrovascular accident, and heart failure, were documented. __________________________________________________________________________________________________________________________________________________ RELATED CONTENT Study: Guidelines for Treating Rheumatoid Arthritis with Systemic Glucocorticoids are Insufficient Study: Methotrexate Combination Offers Rheumatoid Arthritis Benefit Rheumatoid Arthritis Biomarkers: What Are Clinicians Overlooking? __________________________________________________________________________________________________________________________________________________ In comparison with patients without GC, patients with GC showed greater use of non-steroidal anti-inflammatory drugs, and synthetic and biological disease-modifying antirheumatic drugs. In addition, patients with GC had more active disease disability, higher C reactive protein, and anticitrullinated protein antibody levels. A total of 65 events occurred, of which 25 were fractures, were severe infections, 14 were cardiovascular disease, and 7 deaths. Adverse events occurred in 44 patients (11.39%) with GC patients and in 21 patients (9.72%) without GC (p=0.520). Infections occurred more frequently in patients with GC than in patients without GC, although the difference was not significant. “On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273),” the researchers wrote. Overall, the researchers concluded that the analysis of the ESPOIR cohort supported the good safety profile of very low-dose GC for early active RA. However, the researchers cautioned that the drugs should be used with disease-modifying antirheumatic drugs, and at the lowest amounts for the shortest duration possible. —Melissa Weiss Reference: Roubille C, Rincheval N, Dougados M, Flipo RM, Daurès JP, and Combe B. Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort [published online February 17, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2016-210135.