TY - JOUR
T1 - Systematic literature review of observational cohorts and clinical trials into the success rate of glucocorticoid discontinuation after their use as bridging therapy in patients with rheumatoid arthritis
AU - van Ouwerkerk, Lotte
AU - Palmowski, Andriko
AU - Nevins, Isabell S.
AU - Buttgereit, Frank
AU - Verschueren, Patrick
AU - Smolen, Josef S.
AU - Landewé, Robert B. M.
AU - Bijlsma, Johannes J. W.
AU - Kerschbaumer, Andreas
AU - Westhovens, René
AU - Huizinga, Tom W. J.
AU - Allaart, Cornelia F.
AU - Bergstra, Sytske Anne
N1 - Funding Information: Competing interests FB: Consultant of AstraZeneca, AbbVie, Grünenthal, Horizon Pharma, Pfizer, and Roche; grant/research support from AbbVie, Horizon Pharma, Pfizer and Roche. SAB: Received an ASPIRE grant from Pfizer. CFA: received study grants for BeSt and IMPROVED from Centocor (now Janssen) and AbbVie, respectively. RW was consultant for Celltrion, Galapagos and GileadP. Verschueren holds the Pfizer Chair Early Rheumatoid Arthritis Management at KU Leuven and was consultant for ABBVIE, BMS, Celltrion, Eli Lilly, Galapagos, Gilead, Nordic Pharma, Pfizer and UCB. JWJB received study grants from AbbVie and Roche; consultant for Galapagos, Lilly and Sun. AK worked for Speakers bureau, Consultancy at: AbbVie, Amgen, Bristol-Myers Squibb, Eli-Lilly, Gilead, Janssen, Merck Sharp and Dohme, Novartis and Pfizer. RL is a EULAR’s chair of Quality of Care. Publisher Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Objective: To investigate the success rate of glucocorticoid (GC) discontinuation during follow-up in observational cohorts and clinical trials using temporary GC as part of initial therapy ('bridging') in newly diagnosed patients with rheumatoid arthritis (RA). Methods: Systematic literature searches were conducted to identify observational cohorts and clinical trials including patients with RA treated with initial GC bridging therapy, defined as discontinuation of GC within 1 year. Patient percentages still using GC were considered the reverse of successful discontinuation. Random effects meta-analyses were performed stratified by time point. Results: The scoping literature search for observational cohort studies could not identify studies answering the research question. The literature search for clinical trials identified 7160 abstracts, resulting in 10 included studies, with varying type and dose of GC and varying tapering schedules, of which 4 reported sufficient data on GC discontinuation or use after the bridging phase. The pooled proportion of patients who were still or again using GC was 22% (95% CI 8% to 37%, based on four trials) at 12 months and 10% at 24 months (95% CI -1 to 22, based on two trials). Heterogeneity was substantial (I²≥65%). Conclusion: The success rate of GC discontinuation after bridging as part of initial treatment of RA has been described in a limited number of studies. Reports on observational cohorts did not answer the research question. In clinical trials, protocolised discontinuation was mostly successful, although 22% of the patients who started GC bridging therapy still or again used GC at 12 months, and 10% at 24 months.
AB - Objective: To investigate the success rate of glucocorticoid (GC) discontinuation during follow-up in observational cohorts and clinical trials using temporary GC as part of initial therapy ('bridging') in newly diagnosed patients with rheumatoid arthritis (RA). Methods: Systematic literature searches were conducted to identify observational cohorts and clinical trials including patients with RA treated with initial GC bridging therapy, defined as discontinuation of GC within 1 year. Patient percentages still using GC were considered the reverse of successful discontinuation. Random effects meta-analyses were performed stratified by time point. Results: The scoping literature search for observational cohort studies could not identify studies answering the research question. The literature search for clinical trials identified 7160 abstracts, resulting in 10 included studies, with varying type and dose of GC and varying tapering schedules, of which 4 reported sufficient data on GC discontinuation or use after the bridging phase. The pooled proportion of patients who were still or again using GC was 22% (95% CI 8% to 37%, based on four trials) at 12 months and 10% at 24 months (95% CI -1 to 22, based on two trials). Heterogeneity was substantial (I²≥65%). Conclusion: The success rate of GC discontinuation after bridging as part of initial treatment of RA has been described in a limited number of studies. Reports on observational cohorts did not answer the research question. In clinical trials, protocolised discontinuation was mostly successful, although 22% of the patients who started GC bridging therapy still or again used GC at 12 months, and 10% at 24 months.
KW - arthritis
KW - glucocorticoids
KW - methotrexate
KW - rheumatoid
UR - http://www.scopus.com/inward/record.url?scp=85130819098&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/annrheumdis-2022-222338
DO - https://doi.org/10.1136/annrheumdis-2022-222338
M3 - Review article
C2 - 35470162
SN - 0003-4967
VL - 81
SP - 937
EP - 943
JO - Annals of the rheumatic diseases
JF - Annals of the rheumatic diseases
IS - 7
M1 - annrheumdis-2022-222338
ER -