PMID- 36810945
OWN - NLM
STAT- MEDLINE
DCOM- 20230803
LR  - 20230803
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 62
IP  - 8
DP  - 2023 Aug 1
TI  - Safety and efficacy associated with long-term low-dose glucocorticoids in 
      rheumatoid arthritis: a systematic review and meta-analysis.
PG  - 2652-2660
LID - 10.1093/rheumatology/kead088 [doi]
AB  - 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.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      British Society for Rheumatology. All rights reserved. For permissions, please 
      email: journals.permissions@oup.com.
FAU - Palmowski, Andriko
AU  - Palmowski A
AUID- ORCID: 0000-0002-3456-0597
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Berlin, Germany.
AD  - Section for Biostatistics and Evidence-Based Research, The Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
AD  - Division of Rheumatology, University of California San Francisco, San Francisco, 
      CA, USA.
FAU - Nielsen, Sabrina M
AU  - Nielsen SM
AD  - Section for Biostatistics and Evidence-Based Research, The Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
AD  - Research Unit of Rheumatology, Department of Clinical Research, University of 
      Southern Denmark, Odense University Hospital, Odense, Denmark.
FAU - Boyadzhieva, Zhivana
AU  - Boyadzhieva Z
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Berlin, Germany.
FAU - Schneider, Abelina
AU  - Schneider A
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Berlin, Germany.
FAU - Pankow, Anne
AU  - Pankow A
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Berlin, Germany.
FAU - Hartman, Linda
AU  - Hartman L
AD  - Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and 
      Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The 
      Netherlands.
FAU - Da Silva, Jose A P
AU  - Da Silva JAP
AUID- ORCID: 0000-0002-2782-6780
AD  - Rheumatology Department, Centro Hospitalar e Universitario de Coimbra, Portugal, 
      and Institute for Clinical and Biomedical Research (i.CBR) Faculty of Medicine, 
      University of Coimbra, Coimbra, Portugal.
FAU - Kirwan, John
AU  - Kirwan J
AD  - University of Bristol, Bristol, UK.
FAU - Wassenberg, Siegfried
AU  - Wassenberg S
AD  - Rheumazentrum Ratingen, Ratingen, Germany.
FAU - Dejaco, Christian
AU  - Dejaco C
AUID- ORCID: 0000-0002-0173-0668
AD  - Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy.
AD  - Department of Rheumatology and Immunology, Medical University of Graz, Graz, 
      Austria.
FAU - Christensen, Robin
AU  - Christensen R
AD  - Section for Biostatistics and Evidence-Based Research, The Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
AD  - Research Unit of Rheumatology, Department of Clinical Research, University of 
      Southern Denmark, Odense University Hospital, Odense, Denmark.
FAU - Boers, Maarten
AU  - Boers M
AD  - Department of Epidemiology and Biostatistics, and Amsterdam Rheumatology and 
      Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The 
      Netherlands.
FAU - Buttgereit, Frank
AU  - Buttgereit F
AUID- ORCID: 0000-0003-2534-550X
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Berlin, Germany.
LA  - eng
SI  - ClinicalTrials.gov/NCT02585258
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Glucocorticoids)
RN  - VB0R961HZT (Prednisone)
SB  - IM
CIN - Rheumatology (Oxford). 2023 Aug 1;62(8):2635-2636. PMID: 37071699
MH  - Humans
MH  - *Glucocorticoids/adverse effects
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Prednisone/therapeutic use
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - RA
OT  - adverse events
OT  - efficacy
OT  - glucocorticoids
OT  - meta-analysis
OT  - safety
OT  - systematic review
EDAT- 2023/02/23 06:00
MHDA- 2023/08/03 06:43
CRDT- 2023/02/22 15:07
PHST- 2022/12/02 00:00 [received]
PHST- 2023/02/10 00:00 [accepted]
PHST- 2023/08/03 06:43 [medline]
PHST- 2023/02/23 06:00 [pubmed]
PHST- 2023/02/22 15:07 [entrez]
AID - 7050928 [pii]
AID - 10.1093/rheumatology/kead088 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2023 Aug 1;62(8):2652-2660. doi: 
      10.1093/rheumatology/kead088.