RESEARCH - Safety of medium- to long-term glucocorticoid therapy in RA: a meta-analysis

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Rheumatology Advance Access originally published online on May 15, 2009

Rheumatology 2009 48(7):807-811; doi:10.1093/rheumatology/kep096

Safety of medium- to long-term glucocorticoid therapy in rheumatoid

arthritis: a meta-analysis

Vinod Ravindran1, Satish Rachapalli1 and Ernest H. Choy1

1Sir Alfred Baring Garrod Clinical Trials Unit, Academic Department of

Rheumatology, King's College London, London, UK.

Abstract

Objective. Several randomized controlled trials (RCTs) and

meta-analyses have confirmed clinical efficacy of glucocorticoids in

RA. Concerns regarding safety associated with medium- to long-term use

in RA have limited their use in clinical practice. In this

meta-analysis, we assessed the toxicity related to medium- to

long-term (defined as 1 year or longer) glucocorticoid therapy in RA.

Methods. MEDLINE, EMBASE and CINAHL databases were searched for RCTs

of glucocorticoids in RA. RCTs fulfilling the following criteria were

included: double-blinded, placebo-controlled, lasted 1 year or longer,

used prednisolone (or equivalent) and in English. Toxicity was

assessed by number of the patients withdrawn for adverse events (AEs),

and the numbers of serious adverse events (SAEs) and AEs. RCTs were

compared by meta-analysis using odd ratios (OR) with 95% CIs.

Results. Six RCTs with total of 689 patients met the inclusion

criteria. All RCTs lasted 2 years. All studies allowed concomitant use

of NSAIDs and DMARDs. Toxicity of glucocorticoid therapy based on

number of patients withdrawn was limited (OR = 1.09; 95% CI 0.52,

2.25). Using number of AEs per patient-year (OR = 1.19; 95% CI 0.91,

1.57) and SAEs (OR = 1.06; 95% CI 0.67, 1.67) produced similar

results. Efficacy/toxicity ratio was good for glucocorticoid therapy

(number needed to harm/number needed to treat = 0.25).

Conclusion. Medium- to long-term glucocorticoid therapy in RA is

associated with limited toxicity compared to placebo.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/7/807?etoc

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