Three-month tapering and discontinuation of long- term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: placebo-controlled double blind tapering after the GLORIA trial
Authors' conclusion
Tapering prednisolone moderately increases disease activity to the levels of the placebo group (mean still at low disease activity levels) and numerically increases the risk of flare without evidence for adrenal insufficiency.
Study context
- Population
- Patients aged 65+ years with rheumatoid arthritis (RA) who successfully completed the 2-year GLORIA trial periodeligible
- Participants
- 191 patients
- Comparison
- Tapering and stopping prednisolone 5 mg/day vs placebo over 3 months after 2 years of treatment
- Prednisolonen = 76
- Placebon = 79reference
- Primary endpoint
- Change in disease activity (DAS28) after taper (one-sided testing)
- Follow-up
- After 3-month taper
Methodological detailsdouble-blind, placebo-controlled, blinded tapering per protocol, Cortisol and ACTH measured in spot serum samples after tapering in a subset from 3 Dutch centres
- Double-blind
- Placebo-controlled
- Blinded tapering per protocol
- Cortisol and ACTH measured in spot serum samples after tapering in a subset from 3 Dutch centres
Primary result
As reported in the abstract
DAS28 change after taper · follow-up
Prednisolone
0.2
mean · SD 1.0
Placebo
0.0
mean · SD 1.2
Secondary outcomes
| Outcome | Prednisolone | Placebo | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Disease flaresTwo-sided test | 45% | 33% | 1.37 (0.95–1.98) | P = 0.12 | |
| 0.512Relative risk (log scale) |
Safety
- No evidence for adrenal insufficiency
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Three-month tapering and discontinuation of long- term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: placebo-controlled double blind tapering after the GLORIA trial. Ann Rheum Dis. Published 4 August 2023. doi:10.
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