Safety, Efficacy of Glucocorticoids Assessed to Inform 2022 EULAR Recommendations for RA Management

The efficacy of glucocorticoids has been confirmed for the treatment of RA.

The efficacy of glucocorticoids was confirmed in a systematic literature review conducted to inform the 2022 update of the European Alliance of Associations for Rheumatology (EULAR) recommendations for the management of rheumatoid arthritis (RA). Findings of the review were published in Annals of the Rheumatic Diseases.

Regarding efficacy and safety of glucocorticoids, the researchers focused on the effect of newly commenced glucocorticoids (ie, via different routes of administration) as initial bridging therapy and as rescue therapy, as well as the long-term effects of low-dose glucocorticoids. Further, studies reporting the long-term use of glucocorticoids following initial bridging (with or without protocolized tapering) compared with rescue therapy were reviewed.

The steering committee of the EULAR taskforce for the 2022 guideline update for the management of RA developed a protocol that included efficacy, duration of use, and safety of glucocorticoids.

The population of interest included adults with a clinical diagnosis of RA. Different types of glucocorticoids and varying routes of administration (ie, of any dose and duration) were considered. Glucocorticoid therapy was dose- and time-defined, as well as prescribed with other disease-modifying antirheumatic drugs (DMARDs).

Well-known safety risks of GC use have been confirmed, but with heterogeneity between studies.

With regard to efficacy, studies that explored the effectiveness of newly initiated glucocorticoids in combination with DMARDs, as initial treatment or during follow-up, were included in the review. Regarding duration of use, studies that investigated the likelihood of long-term continuation or restarting of glucocorticoids, as well as the effects of withdrawal following initial glucocorticoid bridging, were included. In terms of safety, studies that examined the safety of newly initiated glucocorticoid, along with those assessing the use of chronic low-dose glucocorticoids, were included.

Two of the included studies confirmed the efficacy of glucocorticoid bridging as initial therapy, with equivalent efficacy following 2 years of initiating doses of 30 mg/day compared with 60 mg/day of prednisone. Recent research has shown that the majority of participants commencing initial glucocorticoid bridging were able to discontinue therapy within 12 to 24 months.

The well-known safety risks associated with glucocorticoid use were validated, including increased risk for osteoporotic fractures, diabetes, serious infections, and mortality. Data regarding cardiovascular outcomes were not consistent.

The study authors concluded that “…this [systematic literature review] has confirmed the efficacy of [glucocorticoids] within 12 [to] 24 months. Well-known safety risks of [glucocorticoid] use have been confirmed, but with heterogeneity between studies.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

References:

Bergstra SA, Sepriano A, Kerschbaumer A, et al. Efficacy, duration of use and safety of glucocorticoids: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis. Published online November 21, 2022. doi:10.1136/ard-2022-223358