Prednisolone weaning feasible in Elderly RA Patients Without Substantial Disease Activity Increase

A recent follow-up study published in Annals Of The Rheumatic Diseases by Abdullah Ali Hadi Almayali, MSc, of Amsterdam University Medical Center, and colleagues revealed that elderly patients with rheumatoid arthritis (RA) who received a low dose of 5 mg/day prednisolone as an adjunct to standard care experienced successful weaning from the steroid. Notably, this weaning process did not result in significant increases in disease activity.

Researchers conducted a follow-up analysis of the GLORIA trial, a randomized, placebo-controlled study involving 191 older RA patients. The study aimed to evaluate the impact of adding prednisolone to conventional disease-modifying antirheumatic drug (DMARD) therapy on patient outcomes.

In the study, patients in the prednisolone group were provided with a tapering schedule spanning 3 months. This schedule guided them on when to take 5 mg prednisolone capsules. The tapering process involved skipping designated days, leading up to a reduced frequency of capsule intake.

● At the end of the tapering period, patients who were previously on prednisolone experienced a minimal mean increase in the 28-joint Disease Activity Score (DAS-28) values (0.16 points) compared to the placebo group.

● Although a slightly higher percentage of patients in the prednisolone group experienced disease flares (45% vs. 33% in the placebo group), this difference was not statistically significant.

● Researchers addressed concerns about adrenal insufficiency, a potential adverse effect linked to steroid discontinuation.

● Nine patients on prednisolone developed new adrenal insufficiency symptoms during tapering, but these symptoms subsided in 14 patients who had previously experienced them.

● The researchers concluded that their tapering schedule was sufficient to prevent adrenal insufficiency.

The study highlighted the feasibility and safety of tapering low-dose prednisolone in elderly RA patients. Notably, the study did not include a control arm of patients continuing on low-dose prednisolone. While the findings are promising, the study acknowledged limitations such as potential underpowered outcomes due to patient exclusions and missing data.

This study offers a promising perspective on the successful weaning of prednisolone in elderly RA patients, showcasing a potential avenue for managing RA without triggering substantial disease activity escalation.

Reference:

Annals of the Rheumatic Diseases Almayali AAH, et al "Three-month tapering and discontinuation of long- term, low-dose glucocorticoids in senior patients with rheumatoid arthritis is feasible and safe: placebo-controlled double blind tapering after the GLORIA trial" Ann Rheum Dis 2023; DOI: 10.1136/ard-2023-223977.