Glucocorticoid Tapering Feasible for Rheumatoid Arthritis Patients

For patients with rheumatoid arthritis (RA) achieving low disease activity or remission with tocilizumab (TCZ), glucocorticoid (GC) tapering (GCtaper) is associated with a small but significant increase in disease activity compared with continued GC, but a majority of patients achieve treatment success with either option. These findings were presented at the European Congress of Rheumatology, the annual meeting of the European League Against Rheumatism, held from June 12 to 15 in Madrid.

Gerd R. Burmester, M.D., from Charité-Universitätsmedizin Berlin, and colleagues compared GCtaper with continued GC to maintain disease control in RA patients receiving TCZ. A total of 259 patients in remission or with low disease activity for at least four weeks were randomly assigned to either GCtaper or continued GC 5 mg/day (GC5mg) for 24 weeks while receiving stable TCZ and conventional disease-modifying antirheumatic drugs.

The researchers found that for the primary end point of mean change in Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (DAS28-ESR), the difference between the groups was 0.6 DAS28-ESR units favoring GC5mg. In both arms, a majority of patients achieved treatment success (65 and 77 percent for GCtaper and GC5mg, respectively; relative risk, 0.83; 95 percent confidence interval, 0.71 to 0.97; P = 0.021). RA flare was experienced by 11 and 26 percent of GC5mg and GCtaper patients, respectively.

"On the basis of our results, we believe that all patients achieving low disease activity or remission with tocilizumab should be offered glucocorticoid tapering," Burmester said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry.

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