PMID- 19447767
OWN - NLM
STAT- MEDLINE
DCOM- 20090921
LR  - 20220408
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 48
IP  - 7
DP  - 2009 Jul
TI  - Safety of medium- to long-term glucocorticoid therapy in rheumatoid arthritis: a 
      meta-analysis.
PG  - 807-11
LID - 10.1093/rheumatology/kep096 [doi]
AB  - 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 Toxicity was assessed by number of the patients withdrawn for 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 
      >or=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      of glucocorticoid therapy based on number of patients withdrawn was limited (OR = 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.
FAU - Ravindran, Vinod
AU  - Ravindran V
AD  - Academic Department of Rheumatology, Sir Alfred Baring Garrod Clinical Trials 
      Unit, Weston Education Centre, King's College London, London, UK. 
      drvinod12@gmail.com
FAU - Rachapalli, Satish
AU  - Rachapalli S
FAU - Choy, Ernest H
AU  - Choy EH
LA  - eng
GR  - Arthritis Research UK/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20090515
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Glucocorticoids)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Glucocorticoids/*adverse effects/therapeutic use
MH  - Humans
MH  - Odds Ratio
MH  - Prednisolone/*adverse effects/therapeutic use
MH  - Randomized Controlled Trials as Topic
MH  - Safety
MH  - Treatment Outcome
EDAT- 2009/05/19 09:00
MHDA- 2009/09/22 06:00
CRDT- 2009/05/19 09:00
PHST- 2009/05/19 09:00 [entrez]
PHST- 2009/05/19 09:00 [pubmed]
PHST- 2009/09/22 06:00 [medline]
AID - kep096 [pii]
AID - 10.1093/rheumatology/kep096 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2009 Jul;48(7):807-11. doi: 10.1093/rheumatology/kep096. 
      Epub 2009 May 15.