Oral low-dose glucocorticoids should be included in any recommendation for the use of non-biologic and biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.

Original languageEnglish
Pages (from-to)104-111
Number of pages8
JournalNeuroImmunoModulation
Volume22
DOIs
Publication statusPublished - Nov 7 2014

Fingerprint

Antirheumatic Agents
Glucocorticoids
Rheumatoid Arthritis
Drug Compounding
Expert Testimony
Advisory Committees
Signs and Symptoms
Observational Studies
Appointments and Schedules
Clinical Trials
Guidelines
Cytokines
Safety
Therapeutics
Pharmaceutical Preparations

Keywords

  • Disease-modifying antirheumatic drugs
  • Glucocorticoids
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Endocrinology
  • Immunology
  • Endocrine and Autonomic Systems
  • Neurology
  • Medicine(all)

Cite this

@article{c9e32f64652143babbc3d07be43560f7,
title = "Oral low-dose glucocorticoids should be included in any recommendation for the use of non-biologic and biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis",
abstract = "At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.",
keywords = "Disease-modifying antirheumatic drugs, Glucocorticoids, Rheumatoid arthritis",
author = "Roberto Caporali and Monica Todoerti and Scir{\`e}, {Carlo Alberto} and Carlomaurizio Montecucco and Maurizio Cutolo",
year = "2014",
month = "11",
day = "7",
doi = "10.1159/000362730",
language = "English",
volume = "22",
pages = "104--111",
journal = "NeuroImmunoModulation",
issn = "1021-7401",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Oral low-dose glucocorticoids should be included in any recommendation for the use of non-biologic and biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis

AU - Caporali, Roberto

AU - Todoerti, Monica

AU - Scirè, Carlo Alberto

AU - Montecucco, Carlomaurizio

AU - Cutolo, Maurizio

PY - 2014/11/7

Y1 - 2014/11/7

N2 - At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.

AB - At present, growing scientific evidence from the medical literature and expert opinion provides strong consideration for a mandatory role of glucocorticoids (GCs) in the management of rheumatoid arthritis (RA). Earlier application strategies were based on initial high doses, with subsequent tapering schedules, resulting in dose-related side effects. Recent low-dose GC schemes are more feasible in routine care, while providing evidence of clinical, functional and structural efficacy. Thus, initial low-dose GC 'bridging' treatment on a disease- modifying antirheumatic drug background should be included in any existing recommendations for RA management, as very recently advocated by the EULAR Task Force 2013 updated guidelines. Long-term low-dose therapy appears to provide acceptable safety, leading to long-standing slowing of structural damage, seen even after GC therapy withdrawal. Gaps in knowledge about the optimal method to taper and possibly discontinue GC treatment remain, and this topic should be addressed in clinical trials and observational studies. Recent efforts in GC medication have also included the introduction of a modified-release drug formulation capable of drug delivery consistent with chronobiological pathogenetic rhythms of disease, which has been quite efficacious in controlling the signs and symptoms related to pathways of circadian cytokines. Long-term data will further clarify the add-on benefits of such modified-release formulations.

KW - Disease-modifying antirheumatic drugs

KW - Glucocorticoids

KW - Rheumatoid arthritis

UR - http://www.scopus.com/inward/record.url?scp=84908600395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908600395&partnerID=8YFLogxK

U2 - 10.1159/000362730

DO - 10.1159/000362730

M3 - Article

C2 - 25227117

AN - SCOPUS:84908600395

VL - 22

SP - 104

EP - 111

JO - NeuroImmunoModulation

JF - NeuroImmunoModulation

SN - 1021-7401

ER -