Background Low dose glucocorticoid administration during the night is efficacious on early morning arthritis symptoms [1,2]. Therefore, low dose treatment of prednisone might be administered in the night, during the maximal pick of IL-6 and TNFa, also in Spondyloarthritis (SpA), where steroids are usually not employed.
Objectives To Investigate the clinical efficacy of low dosage of programmed released prednisone (lodotra® 5 mg –Mundipharma Pharmaceuticals-) assumed at 10 p.m, in SpA patients, evaluated with a three months follow up.
Methods 50 SpA patients (19 male and 31 female, mean 55 [14 standard deviation (SD) and 27-86 interval of confidence (CI)], duration of disease mean 5,8 [7,7 SD and 1-48 CI]), all naive from previous glucocorticoids treatment (and out of 15/50 [30%] not treated with DMARDs), were treated for three months with lodotra® 5 mg administration. The results of questionnaires of BASDAI (0-10), fatigue NRS (0-10), axial pain NRS (0-10), peripheral pain NRS (0-10), morning stiffness NRS (0-10) and stiffness duration (minutes) were compared between basal (T0) and after three months therapy (T1) values with Mann Whitney non parametric test.
Results After three months, the difference between activity clinical indices were all significant: BASDAI (mean T0 5,6/10 vs T1 3,2/10 p<0,0001) (figure 1), fatigue NRS (mean T0 6,3/10 vs T1 3,7/10 p<0,005), axial pain NRS (mean T0 5,2/10 vs T1 3,4/10 p<0,05), peripheral pain (mean NRS 6,3/10 vs T1 4,2/10 p<0,0005), stiffness NRS (mean T0 6,5/10 vs T1 3,8/10 p<0,0005) and stiffness duration (mean T0 54,1 vs T1 14,6 minutes, p<0,0001).
Conclusions In naive SpA patients, low dose treatment with programmed timing morning release prednisone, may significantly reduce disease activity and reduce either stiffness or pain.
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Cutolo M et al Efficacy of the switch to modified-release prednisone in rheumatoid arthritis patients treated with standard glucocorticoids. Clin Exp Rheumatol 2013; 31: 498-505
Disclosure of Interest None declared