Glucocorticoid Tapering Doses and Flare Risk Assessed Among Patients With RA

Tapering of glucocorticoids to doses higher than 2.5 mg per day was found to be effective in terms of flare risk in RA.

Glucocorticoid tapering to daily doses of more than 2.5 mg is not significantly associated with higher risk for flares in patients with rheumatoid arthritis (RA), according to study findings published in RMD Open.

Researchers conducted a case-crossover study to determine the association between glucocorticoid tapering and risk for flares in RA.

Eligible patients had a diagnosis of RA, based on the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria.

Glucocorticoid tapering was defined as a reduction in dose from the prior visit.

Time-varying factors were assessed before events (hazard periods, defined as 6 months preceding RA flares) and control periods. The exposure of interest was tapering of glucocorticoids to various doses during the hazard vs control periods.

A total of 508 patients were included in the study, among whom 267 (52.5%) had at least 1 flare during follow-up. Overall, 1545 visits were eligible for analysis, in which 345 (22.3%) flares were reported.

Our study might help define new glucocorticoid reducing strategies, which should aim to doses between 5 and 2.5 mg/day of prednisone equivalent.

Researchers noted that 216 (80.9%) patients with RA were receiving glucocorticoids at baseline, among whom 176 (81.5%) received tapering of glucocorticoids. In 125 of the 216 (57.8%) patients, glucocorticoids were discontinued (ie, tapering to doses of 0 mg/day) at least once.

Discontinuation and tapering to doses up to 2.5 mg/day were associated with higher risk for flares (adjusted odds ratio [aOR], 1.45; 95% CI, 1.13-2.24 and aOR, 1.37; 95% CI, 1.06-2.01, respectively).

However, tapering to doses greater than 2.5 mg/day was not linked to higher risk for flares.  

Study limitations included the lack of generalizability to the entire population with RA, especially those not receiving treatment with disease-modifying antirheumatic drugs (DMARDs) or those with early RA; nonmeasured time-varying confounders, such as infection, may have affected results; and the lack of information on rapidity of tapering, which may have affected flare rate.

Researchers concluded, “Our study might help define new glucocorticoid reducing strategies, which should aim to doses between 5 and 2.5 mg/day of prednisone equivalent.”

References:

Adami G, Fassio A, Rossini M, et al. Tapering glucocorticoids and risk of flare in rheumatoid arthritis on biological disease-modifying antirheumatic drugs (bDMARDs). RMD Open. Published online January 4, 2023. doi:10.1136/rmdopen-2022-002792