期刊
EXPERT REVIEW OF CLINICAL IMMUNOLOGY
卷 8, 期 2, 页码 123-133出版社
TAYLOR & FRANCIS LTD
DOI: 10.1586/eci.11.95
关键词
chronotherapy; circadian; HPA axis; low-dose glucocorticoid; modified release; morning stiffness; prednisone; rheumatoid arthritis
类别
资金
- Horizon Pharma (formerly Nitec Pharma)
- Mundipharma Research Limited
Glucocorticoids are indispensable for the treatment of systemic inflammatory diseases such as rheumatoid arthritis (RA), though their beneficial effects have to be balanced with potential complications arising from high doses, prolonged use or dose splitting. A glucocorticoid formulation (modified-release prednisone) has been developed to be taken in accordance with biological rhythms (chronotherapy). Morning symptoms of RA are caused by elevated nocturnal levels of proinflammatory cytokines, particularly IL-6. Endogenous cortisol levels may be insufficient to counter the inflammatory effects of IL-6. The early morning rise in cortisol can be supplemented with exogenous glucocorticoid replacement therapy if this is given as the recently developed chronotherapy formulation. There is no adverse impact of modified-release prednisone on the hypothalamic-pituitary-adrenal (HPA) axis; indeed, there might be evidence of a beneficial effect on HPA axis function. This review summarizes the development of modified-release prednisone, pharmacokinetic characteristics and clinical experience in patients with RA.
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