Adding prednisone to MTX treatment improves long-term outcomes in early RA
The addition of prednisone to methotrexate (MTX)-based treat-to-target strategy for early rheumatoid arthritis (RA) leads to a lower initiation rate of a first biological disease-modifying antirheumatic drug (bDMARD) and a significant improvement in radiographic outcomes, a study has shown. Furthermore, prednisone use does not increase the incidence of long-term glucocorticoid-related comorbidities.
Researchers retrospectively examined data on prednisone and bDMARD use and onset of glucocorticoid-related comorbidities collected from the second Computer-Assisted Management in Early Rheumatoid Arthritis trial. In this trial, RA patients were treated with methotrexate and either 10 mg prednisone (MTX+pred) or placebo (MTX+plac). At trial completion, prednisone was tapered and stopped, if possible.
Radiographs of hands and feet were evaluated using the Sharp/van der Heijde scoring, while data were analysed using Fisher’s exact and Mann-Whitney U tests.
Post-trial follow-up data were available for 218 of the 236 patients with early RA, with a maximum duration of 11.8 years. During this period, fewer patients in the former MTX+pred group initiated a first bDMARD than in the former MTX+plac group (31 vs 50 percent; p=0.003).
At a follow-up of 2 years post-trial, the median erosion score was significantly lower in the former MTX+pred vs the former MTX+plac group (0; range, 0 to 0 vs 0; 0 to 2; p=0.002).
Onset of glucocorticoid-related comorbidities during the post-trial follow-up did not differ significantly between the two former treatment strategy groups.
Findings of the present study suggest that long-term bDMARD initiation can be reduced by a tight-control and treat-to-target strategy including prednisone, researchers said. Moreover, a lower rate of bDMARD initiation does not appear to negatively affect post-trial radiographic outcome at 2 years.
The introduction of bDMARDs in the treatment of RA is said to have generally led to better disease control and improved functional ability and quality of life. Among the disadvantages of using such agents vs conventional synthetic DMARDs include higher cost and greater risk of severe infections. [RMD Open 2015;1:e000127; Clin Exp Rheumatol 2015;33:737–45; BMJ 2015;351:h3658]