Low-Dose Prednisolone Benefits Older Adults With RA

In older adults with rheumatoid arthritis (RA), add-on low-dose prednisolone had beneficial long-term effects on disease activity and joint damage progression, according to study findings published online ahead of print in the Annals of the Rheumatic Diseases.

“In current practice, many patients with RA are chronically treated with low-dose glucocorticoids, in direct contradiction with guidelines that prescribe only short-term ‘bridge’ therapy in view of the perceived long-term adverse effects,” researchers wrote. “Our study adds substantial evidence to support practice rather than guidelines: add-on chronic prednisolone at 5 mg/day for up to 2 years is effective and not particularly dangerous compared with alternatives.”

The double-blind, randomized placebo-controlled trial (Glucocorticoid LOw-dose in RheumatoId Arthritis, or GLORIA) included 451 patients with active RA who were 65 years and older. To tailor the study design to older patients, researchers minimized exclusion criteria. Participants averaged 2.1 comorbidities, an age of 72, a disease duration of 11 years, and a Disease Activity Score in 28 Joints (DAS28) of 4.5. Some 79% were on disease-modifying treatment, 14% of whom were on biologics.

Average time in the study was 19 months, with 63% of patients randomized to prednisolone 5 mg/day and 61% to placebo completing both years of the 2-year trial.

Patients taking prednisolone had disease activity that was 0.37 points lower and joint damage progression 1.7 points lower than those on placebo, according to the study.

“The trade-off was an 11% increase in the number of patients with at least one adverse event of special interest,” researchers reported, referring to a category that included serious events, glucocorticoid-specific events, and events causing trial discontinuation. Mild to moderate infections requiring treatment were most common.

They characterized the balance of benefit and harm as favorable.

“This is most likely the upper limit of harm to be expected at this dose and treatment duration for patients treated by rheumatologists,” researchers wrote, “and much lower than the estimates from observational studies.”

—Jolynn Tumolo

Reference

Boers M, Hartman L, Opris-Belinski D, et al. Low dose, add-on prednisolone in patients with rheumatoid arthritis aged 65+: the pragmatic randomised, double-blind placebo-controlled GLORIA trial. Ann Rheum Dis. Published online ahead of print May 31, 2022.