Decline of Mean Initial Prednisone Dosage From 10.3 to 3.6 mg/day to Treat Rheumatoid Arthritis Between 1980 and 2004 in One Clinical Setting, With Long‐Term Effectiveness of Dosages Less Than 5 mg/day

Abstract

Results. In the respective 5-year periods, the mean initial prednisone dosages were 10.3, 6.5, 5.1, 4.1, and 3.6 mg/day, with >5 mg/day in 49%, 16%, 7%, 7%, and 3% of patients, 5 mg/day in 51%, 80%, 70%, 26%, and 10% of patients, and <5 mg/day in 0%, 4%, 23%, 67%, and 86% of patients. Most patients received early concomitant methotrexate after 1990, and prednisone <5 mg/day was maintained indefinitely. Patients treated with prednisone >5 mg/day had poorer clinical status as baseline and followup. MDHAQ scores improved similarly in patients treated with <5 or >5 mg/day. Primary adverse events were skin thinning and bruising. New hypertension, diabetes mellitus, and cataracts occurred in <10% of all patients, and <13% of those treated longer than 8 years. Conclusion. The data suggest that many patients with RA might be treated effectively with initial and long-term prednisone <5 mg/day, although further research and observational data are needed to characterize more fully effectiveness and safety.

Time Trends in Glucocorticoid Use in Rheumatoid Arthritis: Results From a Population‐Based Inception Cohort, 1980–1994 Versus 1995–2007

“…Interestingly, we did not note a significant difference in the mean starting dose of GC (in prednisone equivalents) between the 2 incident cohorts (10.3 versus 8.7 mg). This is in contrast to the report by Pincus et al (), who noted a decline in mean initial prednisone dosage from 10.3 mg/day to 3.6 mg/day between 1980 and 2004. Also, there was no difference in the cumulative GC dose over the first year of GC use between the 2 incident cohorts.…”

A Retrospective Analysis of Corticosteroid Utilization Before Initiation of Biologic DMARDs Among Patients with Rheumatoid Arthritis in the United States

“…The issue of corticosteroid safety in RA treatment is further complicated by this study's dosage findings, in which medium dose (defined in this study as 2.5 to\7.5 mg/day) was associated with reduced number of adverse events compared to low dose. This seemingly contradicts recent studies of corticosteroids in RA treatment suggesting that low dosage (even in the long-term) may result in non-significant, limited or mild adverse events [5,6,31]. However, without full access to the medical record of individual patients, it is difficult to fully explain defined low dose as\7.5 mg compared to medium dose of C 7.5 mg, and found that longterm use of medium-dose corticosteroid therapy was associated with an increased prevalence of hypertension in RA patients compared to low dose and no use groups [32].…”

The Past versus the Present, 1980-2004: Reduction of Mean Initial Low-Dose, Long-Term Glucocorticoid Therapy in Rheumatoid Arthritis from 10.3 to 3.6 mg/Day, Concomitant with Early Methotrexate, with Long-Term Effectiveness and Safety of Less than 5 mg/Day

“…At the same time, most of the problems associated with confounding by indication involve increased adverse events associated with higher doses of a medication in patients with more severe clinical status [58,59]. In this report, however, few adverse events were seen [42], possibly not more than expected without therapy. Therefore, confounding by indication may not be a prominent problem in the data presented.…”

“…that patients who have more severe disease are more likely to receive certain therapies or higher doses of such therapies, leading to more adverse events. Indeed, this possibility was documented in the reported series (table 3) [42], as higher doses of prednisone were prescribed for patients who had a more severe clinical status according to MDHAQ scores for physical function, pain and RAPID3. At the same time, most of the problems associated with confounding by indication involve increased adverse events associated with higher doses of a medication in patients with more severe clinical status [58,59].…”