TY - JOUR
T1 - The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis
AU - Konijn, Nicole P. C.
AU - van Tuyl, Lilian H. D.
AU - Boers, Maarten
AU - van de Ven, Peter M.
AU - den Uyl, Debby
AU - ter Wee, Marieke M.
AU - Kerstens, Pit
AU - Voskuyl, AE
AU - van Schaardenburg, Dirkjan
AU - Lems, Willem F.
AU - Nurmohamed, Michael T.
AU - Voskuyl, Alexandre E.
PY - 2016/9
Y1 - 2016/9
N2 - OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.
AB - OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.
KW - Antirheumatic Agents/administration & dosage
KW - Arthritis, Rheumatoid/complications
KW - Body Composition/drug effects
KW - Body Mass Index
KW - Dose-Response Relationship, Drug
KW - Drug Administration Schedule
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Obesity/complications
KW - Overweight/complications
KW - Prednisolone/administration & dosage
U2 - https://doi.org/10.1093/rheumatology/kew221
DO - https://doi.org/10.1093/rheumatology/kew221
M3 - Article
C2 - 27247434
SN - 1462-0324
VL - 55
SP - 1615
EP - 1622
JO - Rheumatology
JF - Rheumatology
IS - 9
ER -