Tapering and discontinuation of oral glucocorticoids without deterioration of disease status in patients with rheumatoid arthritis under a stable treatment

Abstract

Objective

To retrospectively evaluate whether oral glucocorticoid (GC) administration can be tapered or discontinued over a 2-year observation period in patients with rheumatoid arthritis (RA) undergoing a stable oral GC treatment, without deterioration in the disease status.

Methods

Methotrexate (MTX) and prednisolone (PSL) dosages were increased and decreased, respectively, to the maximum extent possible. Concomitant biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) were used as required. Changes in PSL and MTX use and disease status were evaluated at baseline (BL), year-1, and year-2.

Results

Thirty-six patients were enrolled (median age, 65.4 years; disease duration, 7.1 years). The proportion of patients using PSL decreased over 2 years (100–13.9%, p < .0001). While no change was observed in the proportion of patients using MTX, the average administered dose increased at year-1 (p = .06). Moreover, b/tsDMARDs were administered in nine patients (two in year-1, seven in year-2). The Clinical Disease Activity Index remission rate increased from 25.0% to 38.9%. Serious adverse events were identified in two patients.

Conclusions

Oral GC administration was discontinued without deterioration in the rheumatoid arthritis disease control.

Keywords:

• Disease modifying anti-rheumatic drugs (DMARDs); glucocorticoids (GCs)
• methotrexate (MTX)
• rheumatoid arthritis (RA)
• tapering

Conflicts of interest

S.H. received speaker and consultancy fees from AbbVie and Astellas. E.S. received a research grant speaker’s fee from AbbVie, Asahi Kasei Pharma, Astellas Pharma, AYUMI, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly, Janssen, Pfizer, Sanofi, Mitsubishi Tanabe Pharma, and UCB. All other authors have declared no conflicts of interest.

Acknowledgements

We acknowledge Ms. Nozomi Morikawa for data collection and database management.

Additional information

Funding

This work was supported by the JSPS KAKENHI Grants [Funding numbers: 19K08908 to E.S., 19K18499 to S.M., and 19K07940 to S.H.]