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OP0153 The art of tapering glucocorticoids (GC): A systematic review of studies reporting tapering strategies and outcomes in patients with rheumatoid arthritis (RA)
  1. E.R. Volkmann,
  2. S. Rezai,
  3. D.E. Furst,
  4. T. Woodworth
  1. Rheumatology, UCLA, Los Angeles, United States

Abstract

Background Strategies to taper GC in RA vary considerably and the effects of different tapering strategies on clinical outcome measures are unknown.

Objectives To identify GC tapering studies and to evaluate their comparative efficacy and safety with respect to clinical outcomes.

Methods We conducted a systematic literature search in PubMed and Cochrane Central to identify publications from January 1972 to February 2011. Search terms comprised 3 blocks: disease (RA), intervention (GC and related terms) and outcome (withdrawal/tapering). To maximize our yield, tapering was defined as decreasing to 7.5 or 0 mg daily. The review was divided into 3 stages: titles, abstracts, and full articles. Each was assessed by 2 team members and rejected if it fulfilled one of the following exclusion criteria: (1) Not pertaining to adults with RA, (2) Not a case-control study, cohort study, clinical trial, database/registry, (3) Not pertaining to GC withdrawal, (4) Extension study. Discordant assessments were resolved by a third party arbiter (DEF).

Results From an initial listing of 1265 articles, 6 articles met review criteria; each described a different tapering strategy (Table). All were randomized controlled trials. Only 1 study described an objective disease activity measure (DAS44) used to guide the GC taper.2 Only 4 studies reported whether patients successfully tapered/withdrew GC. Among the 251 patients who initiated a taper, 54 (22%) failed to taper/withdraw. Studies with the lowest failure rates included patients with early RA (<1yr), while studies with the highest failure rates included patients with longer disease durations (>1yr). One study compared baseline disease characteristics of patients who successfully versus unsuccessfully tapered and showed that successful tapering was associated with younger age and premenopausal status.3 No studies compared clinical outcome measures or adverse events in patients who successfully versus unsuccessfully tapered.

Table 1

Conclusions There is marked variability in reported GC tapering regimens and many patients fail to withdraw from GC. Well-designed studies, considering age and disease duration, are needed to determine effective and safe strategies for tapering GC.

  1. Lancet 1997;350:309-18.

  2. Arthritis Rheum 2005;52:3381-90.

  3. Scand J Rheumatol 2007;36:351-8.

  4. Ann Rheum Dis 2008;67:656–63.

  5. Ann Rheum Dis 2009;68:1715-1720.

  6. Brit J of Rheumatol 1998;37:930-936.

Disclosure of Interest None Declared

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