Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Successful Tapering of Glucocorticoids (GC) in Rheumatoid Arthritis Patients-Results From the Consortium of Rheumatology Researchers of North America Registry.
Woodworth1, Thasia G., Thomas2, Elizabeth, Greenberg3, Jeffrey D., Furst4, Daniel E.
Rheumatoid arthritis (RA) treatment guidelines currently support short-term use of low dose glucocorticoids (GC) when methotrexate (MTX)/DMARDs treatment is initiated. Discontinuation when disease control is achieved is recommended to limit side effects of chronic use (fracture risk, cataracts, ASHD, diabetes). However, the most reliable approach to tapering and discontinuation is not well known. The purpose of this analysis was to identify factors, including RA flares that influence tapering of GC.
We identified RA patients who achieved stable disease control (CDAI) and stable GC dose over 2 visits (27 months apart), with at least 2 subsequent visits, during treatment with DMARDs and GC in the CORRONA RA database. Time to RA flare, operationally defined as an increase in CDAI by >= 1 category or need for additional GC (oral dose increase or intraarticular) from date of established stable disease, was examined in patients who tapered GC versus those who maintained stable doses. Patients who had less than 12 months of follow-up or/and did not flare were censored. Rate of tapering prednisone dose was compared among patients who tapered and experienced flare in the first year compared to those who tapered without flare. Baseline characteristics that might influence flare events and GC tapering were evaluated.
1076 patients met criteria for analysis, 284 (26.4%) tapering GC (tGC) in year 1 and 792 who remained on stable GC (sGC). CDAI remission/low disease activity was comparable for the tGC group (69.3%) and the sGC group (64.8%). More than half of patients in each group were receiving at least 5 mg/d prednisone, and ~70% were receiving MTX, with more than 60% receiving at least one additional DMARD or/and biologic. Compared to sGC patients, those in the tGC group had fewer flares over time: hazard ratio, 0.697 (95% CI 0.6020.806, p=<0.001). Of 284 tGC patients, 145 did not flare in the first year. Patients without flare decreased dose at a significantly slower rate, 0.47 mg/month versus 0.95 mg/month (p<0.0001), as shown in graph. Baseline factors associated with successful tapering included use of a biologic (p=0.027) and/or MTX (p=0.042), and possibly baseline CDAI (p=0.061).
GC tapering rates in tGC patients not flaring (dotted line) vs flaring (solid line)
Successful tapering without flare was associated with incremental decreases in GC that were about half those associated with flare. Patients with good baseline disease control receiving MTX and/or a biologic appear less likely to flare. Stable GC did not appear to prevent flare.
To cite this abstract, please use the following information:
Woodworth, Thasia G., Thomas, Elizabeth, Greenberg, Jeffrey D., Furst, Daniel E.; Successful Tapering of Glucocorticoids (GC) in Rheumatoid Arthritis Patients-Results From the Consortium of Rheumatology Researchers of North America Registry. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2464