☆ 4.7 Article

Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis

ANNALS OF THE RHEUMATIC DISEASES (2023)

Journal

ANNALS OF THE RHEUMATIC DISEASES

Volume 82, Issue 4, Pages 468-475

Publisher

BMJ PUBLISHING GROUP

DOI: 10.1136/ard-2022-223443

Keywords

arthritis; rheumatoid; glucocorticoids; therapeutics

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Abstract

This study investigated whether patients with rheumatoid arthritis (RA) can discontinue glucocorticoids (GC) after GC 'bridging' in the initial treatment step and identified factors that may affect this. The probability of using GC decreased over time after bridging therapy ended, while the probability of continuous GC use increased. In oral GC bridging studies, the probabilities of later and continuous GC use and the cumulative GC doses were higher compared to studies that included parenteral GC bridging.

ObjectivesTo investigate whether patients with rheumatoid arthritis (RA) can discontinue glucocorticoids (GC) after GC 'bridging' in the initial treatment step and to identify factors that may affect this. MethodsData from 7 clinical trial arms (with 1653 patients) that included a GC bridging schedule, previously identified in a systematic literature search, were combined in an individual patient data meta-analysis. Outcomes were GC use (yes/no) at predefined time points (1/3/6/12/18 months after bridging had ended), cumulative GC dose and continuous (>= 3 months) GC use after bridging had ended. Age, sex, ACPA status, initial GC dose, duration of bridging schedule, oral versus parenteral GC administration and initial co-treatment were univariably tested with each outcome. ResultsThe probability of using GC 1 month after bridging therapy had ended was 0.18, decreasing to 0.07 from 6 until 18 months after bridging had ended. The probability of continuous GC use after bridging had ended was 0.18 at 1 year and 0.30 at 2 years of follow-up. In oral GC bridging studies only, the probabilities of later and continuous GC use and the cumulative GC doses were higher compared to the combined analyses with also parenteral GC bridging studies included. A higher initial dose and a longer GC bridging schedule were associated with higher cumulative GC doses and more patients on GC at 18 months after bridging had ended. ConclusionsBased on these RA clinical trial arms with an initial GC bridging schedule, the probability of subsequent ongoing GC use following bridging is low.

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Glucocorticoid trajectories over 2 years in patients with rheumatoid arthritis in a real-life setting

Alycia Delteil, Celine Lambert, Bruno Pereira, Marion Couderc, Sandrine Malochet-Guinamand, Marie Eva Pickering, Marc Villedon, Sylvain Mathieu, Martin Soubrier, Anne Tournadre

Summary: This study analyzed the use and trajectories of glucocorticoids (GCs) in a real-life cohort of rheumatoid arthritis (RA) patients. The results showed that GCs were used by nearly half of the patients, and the majority of GC users maintained a low dose of GCs over a period of 2 years. These findings highlight the challenges in discontinuing GCs, the lack of consensus regarding the efficacy-safety balance of GCs, and the importance of individualizing GC tapering strategies.

RMD OPEN (2023)