The role of low-dose glucocorticoids for rheumatoid arthritis in the biologic era

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Abstract

In rheumatoid arthritis (RA), low-dose glucocorticoid (GC) therapy has a well-established effecton disease activity. Particularly in early RA, robust evidence demonstrates that GC treatment in association with standard disease- modifying anti-rheumatic drugs (DMARDs) is effective in inducing high remission rates, earlier and more persistently. Despite international recommendations that discouragelong-term concomitant GC use, the majority of the clinical trials and observational registries on biologic agents include a high proportion (up to 80%) of patients in treatment with GC. From an analysisof the literature, a substantial lack of reliable information about the efficacy of GC in associationwith biologic agents emerges; in particular, the role of GC co-therapy in sustaining remission after biological therapy discontinuation remains to be clarified. Given the increasing prevalence of patients in sustained remission, a rational discontinuation strategy should include low-dose GCs in the experimental design to elucidate their role in inducing and maintaining biologic-free remission, for efficacy, safety and pharmacoeconomic considerations.

Original languageEnglish
JournalClinical and Experimental Rheumatology
Volume31
Issue numberSUPPL.78
Publication statusPublished - 2013

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Glucocorticoids
Rheumatoid Arthritis
Biological Factors
Pharmaceutical Economics
Biological Therapy
Antirheumatic Agents
Therapeutics
Biological Products
Registries
Research Design
Clinical Trials
Safety

Keywords

  • Biologics
  • Discontinuation
  • Glucocorticoid
  • Remission
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

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title = "The role of low-dose glucocorticoids for rheumatoid arthritis in the biologic era",
abstract = "In rheumatoid arthritis (RA), low-dose glucocorticoid (GC) therapy has a well-established effecton disease activity. Particularly in early RA, robust evidence demonstrates that GC treatment in association with standard disease- modifying anti-rheumatic drugs (DMARDs) is effective in inducing high remission rates, earlier and more persistently. Despite international recommendations that discouragelong-term concomitant GC use, the majority of the clinical trials and observational registries on biologic agents include a high proportion (up to 80{\%}) of patients in treatment with GC. From an analysisof the literature, a substantial lack of reliable information about the efficacy of GC in associationwith biologic agents emerges; in particular, the role of GC co-therapy in sustaining remission after biological therapy discontinuation remains to be clarified. Given the increasing prevalence of patients in sustained remission, a rational discontinuation strategy should include low-dose GCs in the experimental design to elucidate their role in inducing and maintaining biologic-free remission, for efficacy, safety and pharmacoeconomic considerations.",
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T1 - The role of low-dose glucocorticoids for rheumatoid arthritis in the biologic era

AU - Caporali, Roberto

AU - Scirè, Carlo Alberto

AU - Todoerti, Monica

AU - Montecucco, Carlomaurizio

PY - 2013

Y1 - 2013

N2 - In rheumatoid arthritis (RA), low-dose glucocorticoid (GC) therapy has a well-established effecton disease activity. Particularly in early RA, robust evidence demonstrates that GC treatment in association with standard disease- modifying anti-rheumatic drugs (DMARDs) is effective in inducing high remission rates, earlier and more persistently. Despite international recommendations that discouragelong-term concomitant GC use, the majority of the clinical trials and observational registries on biologic agents include a high proportion (up to 80%) of patients in treatment with GC. From an analysisof the literature, a substantial lack of reliable information about the efficacy of GC in associationwith biologic agents emerges; in particular, the role of GC co-therapy in sustaining remission after biological therapy discontinuation remains to be clarified. Given the increasing prevalence of patients in sustained remission, a rational discontinuation strategy should include low-dose GCs in the experimental design to elucidate their role in inducing and maintaining biologic-free remission, for efficacy, safety and pharmacoeconomic considerations.

AB - In rheumatoid arthritis (RA), low-dose glucocorticoid (GC) therapy has a well-established effecton disease activity. Particularly in early RA, robust evidence demonstrates that GC treatment in association with standard disease- modifying anti-rheumatic drugs (DMARDs) is effective in inducing high remission rates, earlier and more persistently. Despite international recommendations that discouragelong-term concomitant GC use, the majority of the clinical trials and observational registries on biologic agents include a high proportion (up to 80%) of patients in treatment with GC. From an analysisof the literature, a substantial lack of reliable information about the efficacy of GC in associationwith biologic agents emerges; in particular, the role of GC co-therapy in sustaining remission after biological therapy discontinuation remains to be clarified. Given the increasing prevalence of patients in sustained remission, a rational discontinuation strategy should include low-dose GCs in the experimental design to elucidate their role in inducing and maintaining biologic-free remission, for efficacy, safety and pharmacoeconomic considerations.

KW - Biologics

KW - Discontinuation

KW - Glucocorticoid

KW - Remission

KW - Rheumatoid arthritis

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