RESEARCH - Low-dose prednisolone in RA: adverse effects of various DMARDs

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J Rheumatol. 2008 Apr 15

Low-dose Prednisolone in Rheumatoid Arthritis: Adverse Effects of

Various Disease Modifying Antirheumatic Drugs.

Malysheva OA, Wahle M, Wagner U, Pierer M, Arnold S, Häntzschel H, Baerwald CG.

From the Medical Clinic and Polyclinic IV, University Hospital,

Leipzig; and Klinikum der Johann W. Goethe-Universität furt,

Medizinische Klinik II, Rheumatology, furt, Germany.

OBJECTIVE: To assess the incidence and severity of disease modifying

antirheumatic drug (DMARD)-induced adverse effects (AE) in patients

with rheumatoid arthritis (RA) taking/not taking glucocorticoids (GC).

More specifically, we tested whether GC can prolong the survival time

of DMARD in patients receiving combination therapy. METHODS: In a

retrospective study of 154 patients with RA, data were examined for

DMARD therapy and duration of low-dose GC ((3/4) 7.5 mg prednisone

equivalent/day). Patients were followed for 2-62 months, and AE were

graded following WHO criteria. RESULTS: GC therapy significantly

increased the duration of therapy with sulfasalazine (SSZ) from 10.4

+/- 2.3 to 22.5 +/- 1.9 months and for methotrexate (MTX) from 21.8

+/- 2.9 to 43.3 +/- 2.7 months. Stratifying the withdrawal of DMARD

for occurrence of AE and loss of efficacy revealed that GC

comedication significantly increased the time until AE for users of

MTX (3.0 +/- 0.6 vs 18.8 +/- 1.3 mo; p < 0.05), hydroxychloroquine

(HCQ; 34.5 +/- 4.6 vs 54.4 +/- 5.1 mo; p < 0.05), and gold (6.6 +/-

0.9 vs 10.5 +/- 0.9 mo; p < 0.05). In patients taking SSZ the time

until cessation due to loss of efficacy increased significantly under

GC comedication (16.8 +/- 1.2 vs 31.3 +/- 2.9 mo; p < 0.05). However,

in patients taking azathioprine (AZA) the duration of therapy

decreased from 44.4 +/- 2.6 to 22.3 +/- 1.6 months under GC due to

both time until AE and loss of efficacy. Patients under comedication

of MTX + GC, HCQ + GC, and AZA + GC experienced significantly more AE

compared to the respective DMARD monotherapy. A highly significant

reduction was observed in the frequency of erosive RA in patients with

GC comedication (n = 30; 49.1%) compared to patients without low-dose

GC (n = 81, 80.4%; OR 4.05, 95% CI 1.91-8.66, p < 0.0001). CONCLUSION:

Low-dose GC retard radiological progression of RA and exhibit a

differential effect on survival of DMARD and degree of AE due to

DMARD. Further studies are warranted to address safety and

interactions of chronic low-dose GC in RA patients treated with DMARD.

PMID: 18412314

http://www.ncbi.nlm.nih.gov/pubmed/18412314

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