The current relevance and use of prednisone in rheumatoid arthritis

Abstract

Prednisone is an old and very valuable drug in clinical use for over 60 years by now. It is well known by physicians and widely used for different kinds of inflammatory states including rheumatoid arthritis (RA). Clinical trials during the last 20 years have changed its clinical use, particularly with regards to dosage. Today, rheumatologists are treating their patients much more likely over a long period of time using a low-dose scheme. The effectiveness and safety of this low-dose use is the objective of the current clinical research and shall be enlightened in this drug profile. It is also featuring current knowledge about the value of modified-release prednisone with regards to the just published results of the 2nd Circadian Administration of Prednisone in Rheumatoid Arthritis trial. Moreover, the mechanisms of action of prednisone and its relatives will be summed up.

Keywords::

• disease-modifying antirheumatic drugs
• glucocorticoid receptor
• low-dose treatment
• modified-release prednisone
• pharmacodynamics
• pharmacokinetics
• prednisone
• safety concerns

Financial & competing interests disclosure

C Baerwald has received lecture fees from Merck, MSD and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Low-dose prednisone therapy provides disease-modifying antirheumatic drugs (DMARDs) potential in reducing radiographic joint destruction in RA, particularly in combination with synthetic DMARDs.

• Together with DMARDs, remissions can be induced by low-dose prednisone treatment.

• Unwanted adverse effects of low-dose prednisone cannot be neglected, but rather seem to be overestimated. Overall, side effects as well as therapeutic effects are dose dependent.

• With respect to osteoporosis, low-dose prednisone therapy seems to counteract the negative impact of rheumatoid arthritis as an inflammatory disease on bone metabolism.

• Higher prednisone doses are associated with more unwanted drug effects. Therefore, medium to high doses should be strictly limited to the clinical needed period of time.

• Modified-release prednisone improves morning stiffness in RA patients to a meaningful extent.

• Safety and pharmacokinetics of modified-release prednisone are comparable to conventional prednisone formulations.

• New developments like selective GCR agonists might become more important, providing more therapeutic but less side effects.