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.
- arthritis, rheumatoid
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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.
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