Background Glucocorticoids are among the most used and most discussed treatment option for early RA.
Objectives The aim of this study is to evaluate the structural and clinical efficacy of corticotherapy (CT) for recent-onset RA.
Methods We carried out a systematic literature review on PubMed, EMBASE and Cochrane library until July 2013. The research was manually completed by the analysis of all references identified and of all abstracts presented at ACR and EULAR conferences of the past two years. All randomised placebo-controlled trials conducted on adult patients recently diagnosed (<3 years) with RA were selected. Effect Size (ES) and pooled Odds-Ratios were calculated by meta-analysis. In case of significant heterogeneity, random-effects model was used. Sensitivity analyses were based on the dose used (low-dose ≤10mg/day of equivalent prednisone and high-dose) and duration of treatment.
Results Out of 1367 articles, 18 were analysed. These were based on 14 randomised controlled trials involving a total of 2647 patients (mean age=54 years, 67% of women, mean of RA progression=5.4 months). Ten studies were based on low-dose CT and 4 on high-dose CT. We observed a significant higher frequency of remission DAS28 at 3, 6, 12 and 24 months in the CT group. Less structural progressions at 2 years in CT treated patients were also observed (table).
Conclusions CT associated with background treatment of recent-onset RA is quickly effective and induces more remissions at short and medium-term (<2 years) as well as structural benefit. Although safety data must be taken into account, low-dose CT may be recommended in the initial phase on early RA.
Disclosure of Interest : None declared
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