Continuing versus tapering low-dose glucocorticoids in patients with rheumatoid arthritis and systemic lupus erythematosus in states of low disease activity or remission: A systematic review and meta-analysis of randomised trials
Pooled result · Time to flareResult — go to the resultHazard ratio 3.41 95 % CI 1.96–5.93Authors' conclusion
In RA and SLE with low disease activity, continuing low-dose GCs may provide better sustained disease control, but QoE is insufficient. Adrenal insufficiency is very rare when tapering low-dose GCs.
Study context
- Population
- Patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) in low disease activity/remission on glucocorticoids (GCs) at baseline4 trials (3 RA, 1 SLE)
- Participants
- 472 patients
- Comparison
- Continued low-dose GCs vs taper
- Tapered GCsn = 238
- Outcome
- Co-primary: time to flare and AEs
Methodological detailsprotocolised, risk of bias and quality of evidence (QoE) assessed, subgroup analyses for RA
- Protocolised
- Risk of bias and QoE assessed
- Subgroup analyses for RA
Pooled result
Time to flare
Hazard ratio
3.41
95 % CI 1.96–5.93
P < 0.01
Continued low-dose GCs (≤7.5 mg/d prednisone equivalent)vs taper
HR 3.41 (95 % CI 1.96–5.93); P < 0.01
As reported in the abstract
Further pooled results
| Outcome | RR (CI) | |
|---|---|---|
| Withdrawal due to lack of efficacyLow QoE | 3.02 (1.56–5.87) | |
| 0.20.5125Relative risk (log scale) |
| Outcome | MD (CI) | |
|---|---|---|
| DAS28 (RA)Low QoE; DAS28 lower with continued GCs | 0.49 (0.07–0.91) | |
| −0.500.51Difference (linear scale) |
RA subgroup analyses
- Subgroup analyses yielded consistent results
Safety
Adverse events (AEs), serious AEs and withdrawal due to AEs
- Similar risks in both groups
- Very low to low QoE
Adrenal insufficiency in the tapering groups
- Patients in the tapering groups with adrenal insufficiency
- One of 238
Original publication
Continuing versus tapering low-dose glucocorticoids in patients with rheumatoid arthritis and systemic lupus erythematosus in states of low disease activity or remission: A systematic review and meta-analysis of randomised trials. Semin Arthritis Rheum. Published 10 December 2023. doi:10.
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