Efficacy, duration of use and safety of glucocorticoids: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis
Authors' conclusion
In conclusion, this SLR has confirmed the efficacy of GCs in the treatment of RA. In clinical trials, most patients have shown to be able to stop GCs within 12-24 months. Well-known safety risks of GC use have been confirmed, but with heterogeneity between studies.
Study context
- Population
- Rheumatoid arthritis (RA) patients receiving dose- and time-defined GC treatment of any dose and duration (excluding intra-articular glucocorticoids (GCs)) combined with other disease-modifying antirheumatic drugs (DMARDs)safety: 12 RCTs, 21 observational studies
- Comparison
- 30 mg/day prednisone vs 60 mg/day prednisone
- Outcome
- Efficacy of GC bridging as initial therapy
- Follow-up
- 2 years
Methodological detailsdescriptive synthesis, informing the 2022 update of the EULAR RA management recommendations
- Descriptive synthesis
- Informing the 2022 update of the EULAR RA management recommendations
Main finding
As reported in the abstract
- Two studies confirmed efficacy of GC bridging; equal efficacy of 30 mg/day vs 60 mg/day initial prednisone after 2 years
Further findings
Patients continuing GCs after initial GC bridging (clinical trials, based on a recent systematic literature review (SLR))
- Continued on GCs at 12 months
- 22%
- Continued on GCs at 24 months
- 10%
Safety
Safety risks of GC use
- Increased risk of osteoporotic fractures, serious infections, diabetes and mortality confirmed
- CVD outcome data inconsistent
- Risks increased with increasing dose and/or duration; evidence on safe dose conflicting
- 12 RCTs and 21 observational studies
Original publication
Efficacy, duration of use and safety of glucocorticoids: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. Published 21 November 2022. doi:10.
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