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Switch from standard glucocorticoids to modified-release prednisone improved symptoms in RA patients
Patients with rheumatoid arthritis who switched therapies from immediate-release glucocorticoids to low-dose modified-release prednisone experienced significant improvements in their symptoms and disease activity, according to recent study data.
Researchers in Italy conducted an open-label observational 4-month study of 950 patients (mean age, 57 years; 75% women) with rheumatoid arthritis (RA) who had been treating with 6-methyl (6M) prednisolone (n=437) or immediate-release (IR) prednisone (n=513) in combination with disease-modifying antirheumatic drugs, including methotrexate (83.7%). Instead of taking an average daily dose of 9.4 mg IR-prednisone or 6.7 mg 6M prednisolone in the morning, patients were switched to modified-release (MR) prednisone (mean range: 8.2 mg at baseline decreasing to 6.7 mg at endpoint) taken at bedtime.
Outcomes included morning stiffness (MS) duration, pain intensity (numerical rating scale [NRS]), patient and physician global assessment (GA) and Disease Activity Score 28 (DAS28), which were assessed at baseline, 2 and 4 months.
Of the 96.8% of patients who completed the regimen, researchers noted a decrease in MS from 58 ± 37 at baseline to 32 ± 24 at 4 months (P<.001). NRS also declined from 5.4 ± 1.8 to 3.5 ± 1.4, and patient- and physician-GA scores improved from 5.4 ± 1.7 to 3.5 ± 1.4 and 5.1 ± 1.7 to 3.3 ± 1.4, respectively (all values,P<.001). DAS28 decreased from 4.2 ± 1.4 to 3.3 ± 1.2 (P<.001). Improvements were significantly greater for all parameters except DAS28 among patients switched from 6M-prednisolone compared with those switched from IR-prednisone.
“In unselected RA patients chronically treated with standard oral GC, a switch to MR-prednisone given at bedtime induced a significant improvement in duration of MS, pain and global outcomes over a 4-month follow-up period,” the researchers concluded. “These observational data require further confirmation in long-term observational studies.”