Efficacy of the switch to modified-release prednisone in rheumatoid arthritis patients treated with standard glucocorticoids.
OBJECTIVES:
In rheumatoid arthritis (RA), low-dose glucocorticoids (GCs) demonstrate disease-modifying potential when added to DMARDs.Modified-release (MR) prednisone taken at bedtime (released 2am) is more effective than immediate-release (IR) GC taken in the morning.
METHODS:
In an open-label observational study, 950 RA outpatients (mean age 57 ± 13 years; 75% females) treated with GCs and DMARDs (83.7% methotrexate, 10.5% leflunomide; 15.8% biologics) were switched from IR-prednisone or 6-methyl (6M)-prednisolone to low-dose MR-prednisone and followed for 4 months. Morning stiffness duration (MS), pain intensity (numerical rating scale [NRS], 0-10), patient and physician global assessment (GA, 0-10 scale) and disease activity score (DAS28) were assessed at baseline, 2 and 4 months.
RESULTS:
513 patients were switched to MR-prednisone from IR-prednisone (9.4±5.4 mg) and 437 from 6M-prednisolone (6.7±3.7 mg). Among 920 patients (96.8%) completing 4-months' MR-prednisone treatment, MS decreased from 58±37 min at T1 to 32±24 min at endpoint (p<0.001); NRS pain intensity reduced from 5.4±1.8 to 3.5±1.4 (p<0.001), and patient and physician GA scores improved from 5.4±1.7 to 3.5±1.4 and 5.1±1.7 to 3.3±1.4, respectively (p<0.001). DAS28 score decreased from 4.2±1.4 to 3.3±1.2 (p<0.001). Mean daily MR-prednisone dosage decreased from 8.2mg to 6.7mg between baseline and endpoint and significantly higher improvements in MS, NRS pain and GA scores were seen in patientsswitched from 6M-prednisolone versus IR-prednisone. MR-prednisone was well tolerated.
CONCLUSIONS:
Switching GC-treated RA patients to low-dose MR-prednisone significantly improved outcomes over 4 months.
Authors: Cutolo, M. ;Iaccarino, L. ;Doria, A. ;Govoni, M. ;Sulli, A. ;Marcassa, C.
Title: Efficacy of the switch to modified-release prednisone in rheumatoid arthritis patients treated with standard glucocorticoids
Year: 2013
Journal: Clin Exp Rheumatol
Volume: 31
Issue: 4
Pages: 498-505
Pubmed Link: Click here.