Abstract
Objectives
The aim of this study was to assess the safety and efficacy of long-term low-dose glucocorticoids (GCs) in RA.
Methods
A protocolised systematic review and meta-analysis (PROSPERO No. CRD42021252528) of double-blind, placebo-controlled randomised trials (RCTs) comparing a low dose of GCs (≤ 7.5mg/day prednisone) to placebo over at least 2 years was performed. The primary outcome investigated was adverse events (AEs). We performed random-effects meta-analyses and used the Cochrane RoB tool and GRADE to assess risk of bias and quality of evidence (QoE).
Results
Six trials with 1078 participants were included. There was no evidence of an increased risk of AEs (incidence rate ratio 1.08; 95% CI 0.86, 1.34; P = 0.52); however, the QoE was low. The risks of death, serious AEs, withdrawals due to AEs, and AEs of special interest did not differ from placebo (very low to moderate QoE). Infections occurred more frequently with GCs (risk ratio 1.4; 1.19–1.65; moderate QoE). Concerning benefit, we found moderate to high quality evidence of improvement in disease activity (DAS28: −0.23; −0.43 to −0.03), function (HAQ −0.09; −0.18 to 0.00), and Larsen scores (–4.61; −7.52 to −1.69). In other efficacy outcomes, including Sharp van der Heijde scores, there was no evidence of benefits with GCs.
Conclusion
There is very low to moderate QoE for no harm with long-term low dose GCs in RA, except for an increased risk of infections in GC users. The benefit-risk ratio might be reasonable forusing low-dose long-term GCs considering the moderate to high quality evidence for disease-modifying properties.
The aim of this study was to assess the safety and efficacy of long-term low-dose glucocorticoids (GCs) in RA.
Methods
A protocolised systematic review and meta-analysis (PROSPERO No. CRD42021252528) of double-blind, placebo-controlled randomised trials (RCTs) comparing a low dose of GCs (≤ 7.5mg/day prednisone) to placebo over at least 2 years was performed. The primary outcome investigated was adverse events (AEs). We performed random-effects meta-analyses and used the Cochrane RoB tool and GRADE to assess risk of bias and quality of evidence (QoE).
Results
Six trials with 1078 participants were included. There was no evidence of an increased risk of AEs (incidence rate ratio 1.08; 95% CI 0.86, 1.34; P = 0.52); however, the QoE was low. The risks of death, serious AEs, withdrawals due to AEs, and AEs of special interest did not differ from placebo (very low to moderate QoE). Infections occurred more frequently with GCs (risk ratio 1.4; 1.19–1.65; moderate QoE). Concerning benefit, we found moderate to high quality evidence of improvement in disease activity (DAS28: −0.23; −0.43 to −0.03), function (HAQ −0.09; −0.18 to 0.00), and Larsen scores (–4.61; −7.52 to −1.69). In other efficacy outcomes, including Sharp van der Heijde scores, there was no evidence of benefits with GCs.
Conclusion
There is very low to moderate QoE for no harm with long-term low dose GCs in RA, except for an increased risk of infections in GC users. The benefit-risk ratio might be reasonable forusing low-dose long-term GCs considering the moderate to high quality evidence for disease-modifying properties.
| Original language | English |
|---|---|
| Article number | kead088 |
| Pages (from-to) | 2652-2660 |
| Number of pages | 9 |
| Journal | Rheumatology |
| Volume | 62 |
| Issue number | 8 |
| Early online date | 22 Feb 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 22 Feb 2023 |
Bibliographical note
Funding Information:This project is part of the GLORIA project and trial (Glucocorticoid low-dose outcome in rheumatoid arthritis study ( gloriatrial.org ; registered on https://clinicaltrials.gov/ ; identifier NCT02585258) and has received funding from the European Union’s Horizon 2020 Framework Programme for Research and Innovation under grant agreement No. 634886. The Section for Biostatistics and Evidence-Based Research, The Parker Institute, (S.M.N. and R.C.) is supported by a core grant from The Oak Foundation (OCAY-18–774-OFIL), a group of philanthropic organizations giving grants to not-for-profit organizations around the world.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.