Background Glucocorticoids (GC) are very commonly used in the rheumatoid arthritis (RA) treatment; however their potential risks warrants a rational use. 1,2
Objectives Evaluate the impact of biological therapies on GC use in RA in the clinical daily practice.
Methods Descriptive study by reviewing clinical histories of the RA patients (January 2008-December 2010). Patients on GC treatment starting biological therapy were included. Demographic variables, disease variables (duration, RF/ACPA, radiographic erosions, DMARD treatment, previous TNFi or biological treatment) and starting biological, were collected. At baseline (T0), 3 months (T3) and at 1 year (T12), disease activity (DAS28, SDAI), level of functional capacity (HAQ) and the medium dose of GC (prednisone equivalent mg/day) were registered.
At T12, GC medium and cumulative dose for the year was calculated and remission by DAS28, SDAI and the new ACR/EULAR 2011 criteria were evaluated. The GC dose were compared between the group in remission and not in remission.
71 patients (84.5% women), medium age 46.1±13.7 and with a disease duration of 9.8±6 years starting biological therapy were included. 70.4% were RF positive, 71.8% were ACPA positive and the 83.1% had radiographic erosions. New biological treatment (ETN 39.4%, ADA 31%, TCZ 25.4%, RTX 1.4%, ABT 2.8%) was associated with DMARD in 87.3% of patients.
The GC medium dose showed a sadistically reduction from T0 to T3 and T12, from 9.9±5.9mg to 4.9±5.5mg and 2.9±3.5mg respectively. The GC were stopped in 33 patients (46.5%), reduced in 23 patients (32.4%) and remained stable in 11 patients, only 4 patients required and increase of GC. Disease activity decreased significantly in T3 and T12 and an improvement in functional capacity was observed.
A positively, significantly correlation between the GC medium dose and the disease activity by DAS28 was found in T0 (r=0.391; p=0.001), T3 (r=0.398; p=0.001) and T12 (r=0.549; p<0.001) and by SDAI (T0 (r=0.443; p<0.001; T3 (r=0.441; p<0.001; T12 (r=0.663; p<0.001)).
At T12 patients in remission (63.3% by DAS28, 50.7% by SDAI and 33.8% by the ACR/EULAR 2011 criteria) showed less GC treatment with significant differences compared to patients not in remission (table 1).
Conclusions In our series, 78.9% of the patients reduced or even stopped GC treatment in the first year of biological therapy. The reduction in the GC dose was higher in the first 3 months and in those patients who achieved remission at 1 year. The GC medium dose correlated with disease activity. However, in daily practice 20.8-37.8% of the patients in remision, remained on GC treatment.
Gorter SL, Bijlsma JW, Cutolo M, et al. Current evidence of rheumatoid arthritis with glucocorticoids: a systemic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2010; 69 (6): 1010-1014
Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugsAnn Rheum Dis 2010; 69(6): 964-75
Disclosure of Interest None Declared