Long-Term Glucocorticoid Use May Persist After Effective Bridging, Discontinuation

Discontinuation of glucocorticoids (GC) after bridging as part of initial rheumatoid arthritis (RA) treatment appears to be largely successful; however, GC use seems to persist at the 12- and 24-month timepoints after starting bridging therapy, according to study results published in Annals of the Rheumatic Diseases.

The systematic literature review included 4 studies that reported rates of GC use at 12 and/or 24 months after bridging. These studies were taken from an initial identification of 7160 abstracts. The percentage of patients still receiving GCs was treated as the rate of unsuccessful discontinuation. Statistical analysis was performed using random effects meta-analyses categorized by timepoint.

Among the included studies, the rate of GC use at 12 months was 22% (95% CI, 0.08%-0.37%) and at 24 months was 10% (95% CI, -0.01% to 0.22%). The amount of heterogeneity among the studies was I²=99% at 12 months and I²=98% at 24 months.

Limitations to this study included few published data, the lack of a direct answer to the research question, a risk for bias, heterogeneous study designs, and a low rate of randomized controlled trials in the selected literature.

The study researchers concluded, “[D]iscontinuation of GC was successful in the majority of patients with RA within 1 year. . . . 22% [of patients] after 1 year and 10% [of patients] after 2 years were reported to still or again use GC.” However, they indicated that more data “are necessary to identify the optimal GC bridging scheme with the optimal benefit-risk ratio in clinical practice.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

van Ouwerkerk L, Palmowski A, Nevins IS, et al. Systematic literature review of observational cohorts and clinical trials into the success rate of glucocorticoid discontinuation after their use as bridging therapy in patients with rheumatoid arthritis. Published online April 22, 2022. Ann Rheum Dis. doi:10.1136/annrheumdis-2022-222338