Patients with rheumatoid arthritis (RA) who receive bridging therapy are more likely to have low subsequent use of glucocorticoids, according to study results published in Annals of the Rheumatic Diseases.
Researchers aimed to determine the frequency of glucocorticoid use after initial bridging therapy and the factors associated with the continuation of glucocorticoids after bridging among patients with RA.
Researchers conducted a meta-analysis that included data from patients with RA enrolled in 7 clinical studies who received glucocorticoid bridging therapy.
Outcome variables included glucocorticoid use or nonuse at 1, 3, 6, 12, and 18 months after bridging therapy. Other outcomes were cumulative and continued glucocorticoid use for 3 months and longer after bridging. Age, sex, anticitrullinated protein antibodies (ACPA) status, initial glucocorticoid dose, duration of bridging, oral vs parenteral dosing, and initial co-treatment were tested with each outcome variable.
A shorter bridging period and lower glucocorticoid doses at the onset were associated with lower cumulative glucocorticoid doses and fewer patients continuing glucocorticoids at 18 months after bridging. At 1 month, there was a 0.18 probability of glucocorticoid use, which decreased to 0.07 after 6 to 18 months. The probability was 0.18 and 0.30 after 1 and 2 years, respectively.
When examining studies with oral glucocorticoid bridging only vs oral and parenteral bridging, the probabilities of continued glucocorticoid use and the cumulative dosages were higher.
In addition, longer bridging schedules and higher starting glucocorticoid doses correlated with higher cumulative glucocorticoid doses and continued use after 18 months.
Researchers concluded, “A shorter bridging schedule and lower initial GC dose decrease the chance of GC use after bridging has ended.”
van Ouwerkerk L, Boers M, Emery P, et al. Individual patient data meta-analysis on continued use of glucocorticoids after their initiation as bridging therapy in patients with rheumatoid arthritis. Ann Rheum Dis. Published online December 16, 2022. doi:10.1136/ard-2022-223443