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Systematic literature review of observational cohorts and clinical trials into the success rate of glucocorticoid discontinuation after their use as bridging therapy in patients with rheumatoid arthritis
  1. Lotte van Ouwerkerk1,
  2. Andriko Palmowski2,
  3. Isabell S Nevins1,
  4. Frank Buttgereit2,
  5. Patrick Verschueren3,
  6. Josef S Smolen4,
  7. Robert BM Landewé5,6,
  8. Johannes JW Bijlsma7,
  9. Andreas Kerschbaumer4,
  10. René Westhovens3,
  11. Tom WJ Huizinga1,
  12. Cornelia F Allaart1,
  13. Sytske Anne Bergstra1
  1. 1 Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
  2. 2 Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany
  3. 3 Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
  4. 4 Rheumatology, Medical University of Vienna, Wien, Austria
  5. 5 Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
  6. 6 Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
  7. 7 Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Lotte van Ouwerkerk, Rheumatology, Leiden Universitair Medisch Centrum, Leiden, Z-Holland, Netherlands; l.van_ouwerkerk{at}


Objective To investigate the success rate of glucocorticoid (GC) discontinuation during follow-up in observational cohorts and clinical trials using temporary GC as part of initial therapy (‘bridging’) in newly diagnosed patients with rheumatoid arthritis (RA).

Methods Systematic literature searches were conducted to identify observational cohorts and clinical trials including patients with RA treated with initial GC bridging therapy, defined as discontinuation of GC within 1 year. Patient percentages still using GC were considered the reverse of successful discontinuation. Random effects meta-analyses were performed stratified by time point.

Results The scoping literature search for observational cohort studies could not identify studies answering the research question. The literature search for clinical trials identified 7160 abstracts, resulting in 10 included studies, with varying type and dose of GC and varying tapering schedules, of which 4 reported sufficient data on GC discontinuation or use after the bridging phase. The pooled proportion of patients who were still or again using GC was 22% (95% CI 8% to 37%, based on four trials) at 12 months and 10% at 24 months (95% CI −1 to 22, based on two trials). Heterogeneity was substantial (I²≥65%).

Conclusion The success rate of GC discontinuation after bridging as part of initial treatment of RA has been described in a limited number of studies. Reports on observational cohorts did not answer the research question. In clinical trials, protocolised discontinuation was mostly successful, although 22% of the patients who started GC bridging therapy still or again used GC at 12 months, and 10% at 24 months.

  • glucocorticoids
  • arthritis, rheumatoid
  • methotrexate

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  • Handling editor Dimitrios T Boumpas

  • Contributors LvO, ISN and SAB reviewed the clinical trial part of this SLR and conducted the meta-analysis. AP and FB reviewed the observational cohorts part of this SLR. LvO, SAB and CFA have written the manuscript. All authors revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests FB: Consultant of AstraZeneca, AbbVie, Grünenthal, Horizon Pharma, Pfizer, and Roche; grant/research support from AbbVie, Horizon Pharma, Pfizer and Roche. SAB: Received an ASPIRE grant from Pfizer. CFA: received study grants for BeSt and IMPROVED from Centocor (now Janssen) and AbbVie, respectively. RW was consultant for Celltrion, Galapagos and GileadP. Verschueren holds the Pfizer Chair Early Rheumatoid Arthritis Management at KU Leuven and was consultant for ABBVIE, BMS, Celltrion, Eli Lilly, Galapagos, Gilead, Nordic Pharma, Pfizer and UCB. JWJB received study grants from AbbVie and Roche; consultant for Galapagos, Lilly and Sun. AK worked for Speakers bureau, Consultancy at: AbbVie, Amgen, Bristol-Myers Squibb, Eli-Lilly, Gilead, Janssen, Merck Sharp and Dohme, Novartis and Pfizer. RL is a EULAR’s chair of Quality of Care.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.