Randomised controlled trials of glucocorticoids added to DMARDs in early arthritis
| Study | N | Glucocorticoid regimen | Trial duration (years) | Outcome | Results in glucocorticoids group (%) | Results in control group (%) | p Value |
|---|---|---|---|---|---|---|---|
| Machold, 20109 | 383 | Single IM 120 mg methylprednisolone | 1 | Drug-free persistent clinical remission (both at 12 and 52 weeks) | 16.2 | 17.8 | 0.685 |
| Fedorenko, 201110 | 141 | Prednisolone 10 mg/day or Prednisolone 10 mg/day+methylprednisolone 1 g IV first day | 1 | ‘Clinical EULAR remission’ at 12 weeks* | 21.3 (oral GC) | 3.1 | 0.027 |
| 28.6 (oral GC+IV GC) | 0.006 | ||||||
| ‘Clinical EULAR remission’ at 52 weeks* | 37.5 (oral GC) | 11.4 | 0.012 | ||||
| 29.4 (oral GC+IV GC) | 0.133 | ||||||
| Montecucco, 201211 Todoerti, 201012 | 220 | Prednisone 12.5 mg/day for 2 weeks tapered to 6.25 mg/day for the follow-up period† | 1 | DAS28≤3.2 at 52 weeks | 80.2 | 75.5 | 0.44 |
| DAS28<2.6 at 52 weeks | 44.8 | 27.8 | 0.02 | ||||
| Bakker, 201213 | 236 | Prednisone 10 mg/day† | 2 | ACR70 at 104 weeks | 38 | 19, | 0.002 |
| SHS erosion score at 104 weeks | 0 (0–0) | 0 (0–2) | 0.022 | ||||
| SHS total score at 104 weeks | 0 (0–3) | 0 (0–4) | 0.32 |
Studies were of glucocorticoids added to MTX except for the study of Machold et al concerning glucocorticoids added to no other therapy, NSAIDs or DMARDs at the investigators’ discretion.
*Study only reported as an abstract at the 2011 EULAR congress: definition of ‘Clinical EULAR remission’ unclear.
†Tight control, treatment to target.
DAS28, Disease Activity Score in 28 joints; DMARDs, disease-modifying antirheumatic drugs; GC, glucocorticoids; IM, intramuscular; IV, intravenous; MTX, methotrexate; NSAIDs, non-steroidal anti-inflammatory drugs; SHS, median Sharp–van der Heijde score (interquartile range).