Tapering and discontinuation of oral glucocorticoids without deterioration of disease status in patients with rheumatoid arthritis under a stable treatment

Hirata, Shintaro; Kohno, Hiroki; Watanabe, Hirofumi; Tokunaga, Tadahiro; Yoshida, Yusuke; Sugimoto, Toshitsugu; Mokuda, Sho; Oda, Keisuke; Nojima, Takaki; Sugiyama, Eiji

doi:10.1080/14397595.2020.1864914

Cited by 2 publications

(4 citation statements)

References 30 publications

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“…Our study used prespecified, claims-based definitions of both successful glucocorticoid tapering and glucocorticoid discontinuation. Rates of glucocorticoid discontinuation in our cohort were comparable with those seen in prior studies, allowing for differences in follow-up time (5,9,10). We also found that, among the 67% of patients who did not discontinue glucocorticoids within 6 months, an additional one in three reduced their average glucocorticoid dose during that time period.…”

Section: Discussionsupporting

confidence: 84%

“…We demonstrate that, in a population of chronic glucocorticoid users in LDA after escalating b/tsDMARD therapy, more than half tapered glucocorticoids by more than 50%, to a dose of less than or equal to 5 mg/day, within 6 months. One third of these patients were able to discontinue glucocorticoids within 6 months, a rate consistent with that seen previously in international RA cohorts (5,9,10) but lower than that seen in a large randomized clinical trial (7). We used prespecified claims‐based algorithms to define glucocorticoid tapering and discontinuation.…”

Section: Discussionsupporting

confidence: 83%

“…Prior observational work on this topic is limited to relatively small international cohort studies and has produced variable results. In a single‐center Japanese cohort of 36 patients on stable RA treatment regimen that specifically included prednisolone, 58% were able to discontinue prednisolone within 1 year, but the mean dose among persistent users did not significantly change (9). In a secondary analysis from the Japanese Institute of Rheumatology, Rheumatoid Arthritis (IORRA) database, although use and dose of glucocorticoids decreased significantly in patients with established RA who initiated biologic DMARDs (bDMARDs), 51% remained on glucocorticoids 2 years later (10).…”

Section: Introductionmentioning

confidence: 99%

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Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy

Wallace

England

Baker

et al. 2023

ACR Open Rheumatology

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ObjectiveIn the Steroid EliMination In Rheumatoid Arthritis (SEMIRA) trial, 65% of patients with rheumatoid arthritis (RA) in low disease activity (LDA) on stable biologic therapy successfully tapered glucocorticoids. We aimed to evaluate real‐world rates of glucocorticoid tapering among similar patients in the Veterans Affairs Rheumatoid Arthritis registry.MethodsWithin a multicenter, prospective RA cohort, we used registry data and linked pharmacy claims from 2003 to 2021 to identify chronic prednisone users achieving LDA after initiating a new biologic or targeted synthetic disease‐modifying antirheumatic drug (b/tsDMARD). We defined the index date as first LDA occurring 60 to 180 days after b/tsDMARD initiation. The primary outcome of successful tapering, assessed at day 180 after LDA, required a 30‐day averaged prednisone dose both less than or equal to 5mg/day and at least 50% lower than at the index date. The secondary outcome was discontinuation, defined as a prednisone dose of 0 mg/day at days 180 through 210. We used univariate statistics to compare patient characteristics by fulfillment of the primary outcome.ResultsWe evaluated 100 b/tsDMARD courses among 95 patients. Fifty‐four courses resulted in successful tapering; 33 resulted in discontinuation. Positive rheumatoid factor, higher erythrocyte sedimentation rate, more background DMARDs, shorter time from b/tsDMARD initiation to LDA, and higher glucocorticoid dose 30 days before LDA were associated with greater likelihood of successful tapering.ConclusionIn a real‐world RA cohort of chronic glucocorticoid users in LDA, half successfully tapered and a third discontinued prednisone within 6 months of initiating a new b/tsDMARD. Claims‐based algorithms of glucocorticoid tapering and discontinuation may be useful to evaluate predictors of tapering in administrative data sets.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy

Wallace

England

Baker

et al. 2023

ACR Open Rheumatology

View full text Add to dashboard Cite

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“…2 7 Previous clinical investigations have evaluated the feasibility of GC discontinuation by introducing the bDMARD or tofacitinib. [27][28][29][30][31][32] For example, Inoue et al analysed 80 patients with RA taking a median PSL dose of 5.0 (1.0-10.0) mg/day at bDMARDs initiation. 31 Over a median follow-up of 33.1 months, 31.3% of participants discontinued GC.…”

Section: Discussionmentioning

confidence: 99%

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

Xie

Hao

et al. 2021

Ann Rheum Dis

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ObjectiveTo unravel the dynamical trajectory and features of glucocorticoids (GC) tapering and discontinuation in patients with rheumatoid arthritis (RA) commencing GC with concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).MethodsWe used data from longitudinal real-world Treat-to-TARget in RA cohort. Patients with RA who started GC and contaminant csDMARDs therapy were included. The changes in GC dose and disease activity were evaluated. GC discontinuation rate was analysed using Kaplan-Meier analysis. The relapse profile within 6 months after GC discontinuation was also analysed.ResultsA total of 207 patients with RA were included. During a median follow-up of 38.6 months, 124 patients discontinued GC. The median prednisolone dose of 10 (5–10) mg/day at initiation was reduced by 50% in the first 6 months and then more slowly, to zero by 48 months eventually. The cumulative probabilities of GC discontinuation were 9.7%, 26.6%, 48.0% and 58.6% at month 6, years 1, 2 and 3, with calculated median time to GC cessation of 27 months. In 110 DMARD-naïve patients, the corresponding cumulative probabilities of GC discontinuation were, respectively, 12.7%, 30.0%, 50.9% and 60.6%, with calculated median time to GC cessation of 24 months. Of the 124 patients who discontinued GC, adding other csDMARDs or concomitant csDMARDs increment was documented in 28.2% of them. Approximately half of 124 patients were in clinical remission at GC discontinuation. Within 6 months after GC withdrawal, 79.1% (91/115) of patients maintained relapse free.ConclusionsIn patients with RA commencing GC besides csDMARDs, GC is feasibly discontinued with favourable control of disease activity in real-life setting, mostly without short-term flare. But the withdrawal time is far from reaching the recommended time frame, indicating the gap between real-world practice and current guidelines.

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Tapering and discontinuation of oral glucocorticoids without deterioration of disease status in patients with rheumatoid arthritis under a stable treatment

Cited by 2 publications

References 30 publications

Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy

Lowering Expectations: Glucocorticoid Tapering Among Veterans With Rheumatoid Arthritis Achieving Low Disease Activity on Stable Biologic Therapy

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

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