PMID- 38100900
OWN - NLM
STAT- MEDLINE
DCOM- 20240112
LR  - 20240403
IS  - 1532-866X (Electronic)
IS  - 0049-0172 (Linking)
VI  - 64
DP  - 2024 Feb
TI  - Continuing versus tapering low-dose glucocorticoids in patients with rheumatoid 
      arthritis and systemic lupus erythematosus in states of low disease activity or 
      remission: A systematic review and meta-analysis of randomised trials.
PG  - 152349
LID - S0049-0172(23)00191-9 [pii]
LID - 10.1016/j.semarthrit.2023.152349 [doi]
AB  - OBJECTIVES: To study the benefit and harm associated with continuing versus 
      tapering low-dose glucocorticoids (GCs) in patients with rheumatoid arthritis 
      (RA) and systemic lupus erythematosus (SLE) who have achieved low disease 
      activity/remission. METHODS: A protocolised (PROSPEROCRD42022325175) systematic 
      review and meta-analysis of randomised trials was performed. Trials compared, in 
      patients with low disease activity/remission and GCs at baseline, continued 
      low-dose GCs (</=7.5 mg/d prednisone equivalent) with a taper. Co-primary outcomes 
      were time to flare and adverse events (AEs), accompanied by secondary benefit and 
      harm outcomes. We performed meta-analyses and evaluated risk of bias and quality 
      of evidence (QoE). Subgroup analyses were conducted for patients with RA. 
      RESULTS: Four trials (three: RA; one: SLE; study duration 24-104 weeks) with 472 
      participants were included. Tapering GCs resulted in a shorter time to flare 
      (hazard ratio 3.41 [95 %-CI 1.96-5.93]; p<0.01; very low QoE). The risks of AEs, 
      serious AEs, and withdrawal due to AEs were similar in both groups (very low to 
      low QoE). There were more withdrawals due to lack of efficacy with tapered GCs 
      (risk ratio 3.02 [1.56-5.87]; low QoE). In RA, the disease activity score-28 was 
      lower with continued GCs (mean difference 0.49 [0.07-0.91]; low QoE). One of 238 
      patients in the tapering groups experienced adrenal insufficiency. Subgroup 
      analyses yielded consistent results. CONCLUSION: In RA and SLE with low disease 
      activity, continuing low-dose GCs may provide better sustained disease control, 
      but QoE is insufficient. Adrenal insufficiency is very rare when tapering 
      low-dose GCs. Longer-term safety concerns for GCs remain.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Palmowski, Andriko
AU  - Palmowski A
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Germany; Section for Biostatistics and Evidence-Based Research, the 
      Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark. Electronic 
      address: andriko.palmowski@charite.de.
FAU - Pankow, Anne
AU  - Pankow A
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Germany.
FAU - Terziyska, Kalina
AU  - Terziyska K
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Germany.
FAU - Nielsen, Sabrina M
AU  - Nielsen SM
AD  - Section for Biostatistics and Evidence-Based Research, the Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Denmark; Research Unit of Rheumatology, 
      Department of Clinical Research, University of Southern Denmark, Odense 
      University Hospital, Denmark.
FAU - Christensen, Robin
AU  - Christensen R
AD  - Section for Biostatistics and Evidence-Based Research, the Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Denmark; Research Unit of Rheumatology, 
      Department of Clinical Research, University of Southern Denmark, Odense 
      University Hospital, Denmark.
FAU - Bliddal, Henning
AU  - Bliddal H
AD  - Section for Biostatistics and Evidence-Based Research, the Parker Institute, 
      Bispebjerg and Frederiksberg Hospital, Denmark.
FAU - Boyadzhieva, Zhivana
AU  - Boyadzhieva Z
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Germany.
FAU - Buttgereit, Frank
AU  - Buttgereit F
AD  - Department of Rheumatology and Clinical Immunology, Charite - Universitatsmedizin 
      Berlin, Germany.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20231210
PL  - United States
TA  - Semin Arthritis Rheum
JT  - Seminars in arthritis and rheumatism
JID - 1306053
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Humans
MH  - *Adrenal Insufficiency/chemically induced/drug therapy
MH  - *Antirheumatic Agents/therapeutic use
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Glucocorticoids/adverse effects
MH  - *Lupus Erythematosus, Systemic/drug therapy
MH  - Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - Flare
OT  - Glucocorticoids
OT  - Rheumatoid arthritis
OT  - Systemic lupus erythematosus
OT  - Tapering
COIS- Declaration of Competing Interest AP has received honoraria from Novartis for 
      participating in advisory boards (unrelated to this manuscript). FB has received 
      consultancy fees, honoraria and travel expenses from Abbvie, Pfizer, Gruenenthal, 
      and Horizon Therapeutics, all unrelated to this manuscript. The other authors 
      declare no conflicts of interest
EDAT- 2023/12/16 11:43
MHDA- 2024/01/12 06:43
CRDT- 2023/12/15 18:01
PHST- 2023/09/18 00:00 [received]
PHST- 2023/11/28 00:00 [revised]
PHST- 2023/12/05 00:00 [accepted]
PHST- 2024/01/12 06:43 [medline]
PHST- 2023/12/16 11:43 [pubmed]
PHST- 2023/12/15 18:01 [entrez]
AID - S0049-0172(23)00191-9 [pii]
AID - 10.1016/j.semarthrit.2023.152349 [doi]
PST - ppublish
SO  - Semin Arthritis Rheum. 2024 Feb;64:152349. doi: 10.1016/j.semarthrit.2023.152349. 
      Epub 2023 Dec 10.