Factors associated with discontinuation of glucocorticoids after starting biological disease-modifying antirheumatic drugs in rheumatoid arthritis patients

Abstract

Objectives: Glucocorticoids (GCs) are effective treatments for rheumatoid arthritis (RA) but long-term use has adverse effects. This study aimed to elucidate whether GCs can be discontinued by introducing biological disease-modifying antirheumatic drugs (bDMARDs) and the factors influencing the outcome.

Method: We included RA patients who had been orally taking GCs at the initiation of bDMARDs. The changes in GC dose after starting bDMARDs were evaluated and the GC discontinuation rate was analyzed using Kaplan–Meier analysis. The factors associated with discontinuation of GCs were assessed by Cox hazard models.

Results: Eighty RA patients were included in the study. The dosage of oral prednisolone (PSL) was significantly reduced from 5.0 to 3.0 mg/day by 3 months (p = .013). GCs were discontinued in 31.3% of patients and the median time until GC discontinuation was 10.1 months. The GC discontinuation rate was significantly higher in patients with Class 1 and 2 (p = .024), with an initial PSL dose <5 mg/day (p = .040), and with low DAS28(ESR) (p = .038). In multivariate analyses, higher DAS28(ESR) (odds ratio, 0.200; p = .039), and higher PSL dose (odds ratio, 0.748; p = .029) were significantly associated with less frequent GC discontinuation.

Conclusion: DAS28(ESR) high and PSL dose were factors associated with discontinuation of GC use after starting bDMARDs.

Keywords:

• Biologics
• discontinuation
• DMARDs
• glucocorticoids
• rheumatoid arthritis

Acknowledgements

The authors thank Drs. K. Kubo, H. Shoda, S. Sumitomo, H. Harada, Y. Iwasaki, O. Sasaki, Y. Nagafuchi, Y. Tsuchida, M. Shibuya, L. Akahira, K. Michishita, and E. Bannai for the collection of clinical data. We are grateful to M. Tanaka and A. Fujikawa for their assistance.

Conflict of interest

K.F. received financial support or fees from Astellas, BMS, Daiichi-Sankyo, Mitsubishi Tanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, UCB, Janssen, Eli Lilly, and NIPPON KAYAKU. H.K. has received consulting fees, speaking fees, and/or honoraria from Astellas, Eisai, Bristol-Myers, Pfizer Japan, Daiichi-Sankyo, Janssen, Novartis and Eli Lilly. The Department of Immunotherapy Management, Graduate School of Medicine, University of Tokyo had courses endowed by Tanabe Mitsubishi Pharma, Chugai Pharmaceutical, Ayumi Pharmaceutical, Taisho Toyama Pharmaceutical, Nippon Kayaku, UCB Japan, and AbbVie.