The results of a randomised controlled trial presented at EULAR 2019 demonstrate high levels of treatment success in approximately two-thirds of patients despite tapered glucocorticoid (GC) discontinuation, while a small loss of disease control was observed at the total study population level.
“On the basis of our results, we believe that all patients achieving low disease activity or remission with tocilizumab should be offered glucocorticoid tapering,” said Prof Gerd R Burmester, Department of Rheumatology and Clinical Immunology, Charité –University Medicine Berlin, Germany.
The study included 259 patients with RA taking GC therapy (prednisone 5mg/day) as well tocilizumab with or without a conventional synthetic disease modifying anti-rheumatic drug (csDMARD) for 24 weeks or more.
Results show that, after 24 weeks, a small but significant difference in disease activity following GC tapering with a between arm difference of 0.6 DAS 28-ESR units (95% CI: 0.3-0.9; p<0.001). However, most patients in both arms achieved treatment success at the end of the study (77 per cent of continued GC and 65 per cent of GC taper, p=0.021). Flares were experienced in 26 per cent of GC taper patients and 11 per cent of those on continued GC, although only one patient in the study (continued GC group) discontinued blinded treatment due to insufficient flare control. Serious adverse events (no deaths) were reported for 5 per cent of the continued GC group and 3 per cent of the GC taper group. No patients had symptomatic adrenal insufficiency.
“The risk to benefit profile of glucocorticoid therapy in rheumatoid arthritis is very controversial,” said Prof John D Isaacs, Chairperson of the Abstract Selection Committee, EULAR.
“We welcome these data to inform our understanding in this area and ultimately the better management of patients suffering with this disease.”