In the era of disease-modifying antirheumatic drugs, how close are we to treating rheumatoid arthritis without the use of glucocorticoids?
DMARDs
Glucocorticoids
Rheumatoid arthritis
TReasure
Target dose
Journal
Rheumatology international
ISSN: 1437-160X
Titre abrégé: Rheumatol Int
Pays: Germany
ID NLM: 8206885
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
03
05
2021
accepted:
28
06
2021
pubmed:
7
7
2021
medline:
15
1
2022
entrez:
6
7
2021
Statut:
ppublish
Résumé
We wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of ≤ 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25-116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of ≥ 7.5 mg/day was found to be crucial in not reaching the GC target dose (p < 0.001, OR 39.0 (24.1-63.2)). The initial GC dose of ≥ 7.5 mg/day, female gender, age, RF positivity, high DAS28, and VAS pain level were all highly related for GC continuation. Despite the use of DMARDs, our data revealed that we are still far from achieving our goal of treating RA without using steroids.
Identifiants
pubmed: 34226947
doi: 10.1007/s00296-021-04939-8
pii: 10.1007/s00296-021-04939-8
doi:
Substances chimiques
Antirheumatic Agents
0
Glucocorticoids
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1915-1924Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Singh JA, Saag KG, Louis Bridges Jr S et al (2016) 2015 American college of rheumatology guidelines for the treatment of rheumatoid arthritis. Arthritis Care Res 68:1–25. https://doi.org/10.1002/acr.22783
doi: 10.1002/acr.22783
Smolen JS, Landewé R, Bijlsma J et al (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76:960–977. https://doi.org/10.1136/annrheumdis-2016-210715
doi: 10.1136/annrheumdis-2016-210715
pubmed: 28264816
Tanaka Y (2013) Next stage of RA treatment: is TNF inhibitor-free remission a possible treatment goal? Ann Rheum Dis 72(Suppl 2):ii124–ii127. https://doi.org/10.1136/annrheumdis-2012-202350
doi: 10.1136/annrheumdis-2012-202350
pubmed: 23253919
Spivey CA, Griffith J, Kaplan C et al (2018) A Retrospective analysis of corticosteroid utilization before initiation of biologic DMARDs among patients with rheumatoid arthritis in the United States. Rheumatol Ther 5(1):255–270. https://doi.org/10.1007/s40744-017-0089-8
doi: 10.1007/s40744-017-0089-8
pubmed: 29204858
Gotzsche PC, Johansen HK (2005) Short-term low dose corticosteroids vs placebo and nonsteroidal anti-inflammatory drugs in rheumatoid arthritis. Cochrane Database Syst Rev 1:CD000189. https://doi.org/10.1002/14651858.CD000189.pub2
doi: 10.1002/14651858.CD000189.pub2
van der Veen MJ, Bijlsma JW (1993) The effect of methylprednisolone pulse therapy on methotrexate treatment of rheumatoid arthritis. Clin Rheumatol 12:500–505. https://doi.org/10.1007/BF02231779
doi: 10.1007/BF02231779
pubmed: 8124913
Harris ED Jr, Emkey RD, Nichols JE et al (1983) Low dose prednisone therapy in rheumatoid arthritis: a double-blind study. J Rheumatol 10:713–721
pubmed: 6358491
Kirwan JR (1995) The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The arthritis and rheumatism council low-dose glucocorticoid study group. N Engl J Med 333(142):146. https://doi.org/10.1056/NEJM199507203330302
doi: 10.1056/NEJM199507203330302
van Everdingen AA, Jacobs JWG, Siewertsz DR, Reesema V et al (2002) Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 136:1–12. https://doi.org/10.7326/0003-4819-136-1-200201010-00006
doi: 10.7326/0003-4819-136-1-200201010-00006
pubmed: 11777359
Black RJ, Lester S, Buchbinder R et al (2017) Factors associated with oral glucocorticoid use in patients with rheumatoid arthritis: a drug use study from a prospective national biologics registry. Arthritis Res Ther 19(1):253. https://doi.org/10.1186/s13075-017-1461-3
doi: 10.1186/s13075-017-1461-3
pubmed: 29141677
pmcid: 5688724
Hardy R, Cooper MS (2018) Unravelling how glucocorticoids work in rheumatoid arthritis. Nat Rev Rheumatol 14(10):566–567. https://doi.org/10.1038/s41584-018-0079-4
doi: 10.1038/s41584-018-0079-4
pubmed: 30181582
Smolen JS, Landewé RBM, Bijlsma JWJ et al (2020) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 79(6):685–699. https://doi.org/10.1136/annrheumdis-2019-216655
doi: 10.1136/annrheumdis-2019-216655
pubmed: 31969328
Smolen JS, Landewé R, Breedveld FC et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73(3):492–509. https://doi.org/10.1136/annrheumdis-2013-204573
doi: 10.1136/annrheumdis-2013-204573
pubmed: 24161836
Kalyoncu U, Taşcılar EK, Ertenli Aİ et al (2018) Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci 48(4):856–861. https://doi.org/10.3906/sag-1807-200
doi: 10.3906/sag-1807-200
pubmed: 30119164
Buttgereit F, da Silva JAP, Boers M et al (2002) Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis 61:718–722. https://doi.org/10.1136/ard.61.8.71872210.1136/ard.61.8.718
doi: 10.1136/ard.61.8.71872210.1136/ard.61.8.718
pubmed: 12117678
pmcid: 1754188
Ramiro S, Sepriano A, Chatzidionysiou K et al (2017) Safety of synthetic and biological DMARDs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 76(6):1101–1136. https://doi.org/10.1136/annrheumdis-2016-210708
doi: 10.1136/annrheumdis-2016-210708
pubmed: 28298374
Nam JL, Takase-Minegishi K, Ramiro S et al (2017) Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 76(6):1113–1136. https://doi.org/10.1136/annrheumdis-2016-210713
doi: 10.1136/annrheumdis-2016-210713
pubmed: 28283512
Strehl C, Bijlsma JWJ, de Wit M et al (2016) Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate the implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis 75:952–957. https://doi.org/10.1136/annrheumdis-2015-208916
doi: 10.1136/annrheumdis-2015-208916
pubmed: 26933146
Albrecht K, Callhoff J, Schneider M et al (2015) High variability in glucocorticoid starting doses in patients with rheumatoid arthritis: observational data from an early arthritis cohort. Rheumatol Int 35:1377–1384. https://doi.org/10.1007/s00296-015-3229-x
doi: 10.1007/s00296-015-3229-x
pubmed: 25663291
Cardiel MH, Pons-Estel BA, Sacnun MP et al (2012) Treatment of early rheumatoid arthritis in a multinational inception cohort of Latin American patients: the GLADAR experience. J Clin Rheumatol 18:327–335. https://doi.org/10.1097/RHU.0b013e31826d6610
doi: 10.1097/RHU.0b013e31826d6610
pubmed: 23047532
McKeown E, Bykerk VP, De Leon F et al (2012) Quality assurance study of the use of preventative therapies in glucocorticoid-induced osteoporosis in early inflammatory arthritis: results from the CATCH cohort. Rheumatol (Oxf) 51:1662–1669. https://doi.org/10.1093/rheumatology/kes079
doi: 10.1093/rheumatology/kes079
Roubille C, Rincheval N, Dougados M et al (2017) Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort. Ann Rheum Dis 76(11):1797–1802. https://doi.org/10.1136/annrheumdis-2016-210135
doi: 10.1136/annrheumdis-2016-210135
pubmed: 28213564
Puar THK, Stikkelbroeck NMML, Smans LCCJ et al (2016) Adrenal crisis: still a deadly event in the 21st century. Am J Med 129(3):339.e1–9. https://doi.org/10.1016/j.amjmed.2015.08.021
doi: 10.1016/j.amjmed.2015.08.021
Paragliola RM, Papi G, Pontecorvi A et al (2017) Treatment with synthetic glucocorticoids and the hypothalamus-pituitary-adrenal axis. Int J Mol Sci. https://doi.org/10.3390/ijms18102201
doi: 10.3390/ijms18102201
pubmed: 29053578
pmcid: 5666882