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• Correspondence on Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis
  Young Ho Lee
  Published on: 23 January 2023

• Published on: 23 January 2023

  Correspondence on Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis

  • Young Ho Lee, Professor Korea University

  We are submitting a correspondence in regards to the paper "Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis" by Lotte van Ouwerkerk et al.1 published in Ann Rheum Dis. 2022 Dec 16. The study is an important contribution to the field as it aimed to investigate the effectiveness of glucocorticoids (GC) as a bridging therapy for rheumatoid arthritis (RA) patients. The study combined data from 7 clinical trial arms that included GC bridging schedule in the initial treatment of RA, to investigate whether patients with RA can discontinue GC after GC 'bridging' and to identify factors that may affect this. The study has several strengths, such as the use of individual patient data meta-analysis which allows for a more comprehensive and detailed analysis. Additionally, the study's aim to investigate the effectiveness of GC as a bridging therapy is admirable, as it addresses an important question in the field of RA treatment2 3. However, the study also has some limitations that must be taken into account when interpreting the results. Firstly, the sample size of 1653 patients may not be representative of the general population of RA patients. This could limit the generalizability of the study's findings and may not fully capture the diversity of RA patients. Additionally, the study's short-term follow-up period of 18 months may not be enough...

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  We are submitting a correspondence in regards to the paper "Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis" by Lotte van Ouwerkerk et al.1 published in Ann Rheum Dis. 2022 Dec 16. The study is an important contribution to the field as it aimed to investigate the effectiveness of glucocorticoids (GC) as a bridging therapy for rheumatoid arthritis (RA) patients. The study combined data from 7 clinical trial arms that included GC bridging schedule in the initial treatment of RA, to investigate whether patients with RA can discontinue GC after GC 'bridging' and to identify factors that may affect this. The study has several strengths, such as the use of individual patient data meta-analysis which allows for a more comprehensive and detailed analysis. Additionally, the study's aim to investigate the effectiveness of GC as a bridging therapy is admirable, as it addresses an important question in the field of RA treatment2 3. However, the study also has some limitations that must be taken into account when interpreting the results. Firstly, the sample size of 1653 patients may not be representative of the general population of RA patients. This could limit the generalizability of the study's findings and may not fully capture the diversity of RA patients. Additionally, the study's short-term follow-up period of 18 months may not be enough time to understand the long-term effects of GC bridging therapy. Long-term follow-up is essential to understand the durability of treatment effects and potential side effects. Furthermore, the study's focus on the specific GC bridging schedule used in the clinical trials may not be generalizable to other GC bridging schedules used in clinical practice. This could limit the applicability of the study's findings to clinical practice. The study also found that oral GC bridging studies only, the probabilities of later and continuous GC use and the cumulative GC doses were higher compared to the combined analyses with also parenteral GC bridging studies included. This finding may be misleading as the oral GC bridging studies only were not randomized, which could have introduced bias. Randomization is important to ensure that the groups being compared are similar and to reduce the likelihood of bias4. In conclusion, while this study provides some insights into the use of GC as a bridging therapy in RA, its results must be viewed with caution given its limitations. Further research with larger sample sizes, longer follow-up periods, and randomized controlled trial are needed to fully understand the effects of GC bridging therapy on RA patients and to determine if patients can discontinue GC after GC 'bridging.'

  REFERNECES
  1 van Ouwerkerk L, Boers M, Emery P, et al. Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 2022
  2 Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis & Rheumatology 2021;73:1108-23.
  3 Hua C, Buttgereit F, Combe B. Glucocorticoids in rheumatoid arthritis: current status and future studies. RMD open 2020;6:e000536.
  4 Akobeng AK. Understanding randomised controlled trials. Archives of disease in childhood 2005;90:840-4.

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  Conflict of Interest:
  None declared.

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