Tocilizumab-treated RA patients with LDA ‘should be considered’ for glucocorticoid tapering
medwireNews: Findings from a randomized controlled trial suggest that glucocorticoid tapering is a feasible strategy for rheumatoid arthritis (RA) patients who achieve low disease activity (LDA) or remission during treatment with tocilizumab and long-term glucocorticoids.
The trial included 259 patients treated with glucocorticoids at a prednisone-equivalent dose of 5– 15 mg/day for 24 weeks or more, Gerd Burmester (Charité-Universitätsmedizin Berlin, Germany) told delegates at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois, USA.
He added that all participants were in LDA or remission according to a DAS28-ESR score of 3.2 points or lower, and had been receiving concomitant treatment with tocilizumab, with or without conventional DMARDs, for at least 4 weeks prior to study baseline.
Burmester reported that the 131 patients who were randomly assigned to undergo blinded glucocorticoid taper – involving a 1 mg/day reduction in prednisone dose every 4 weeks to 0 mg/day at week 16–24 – experienced an increase in average DAS28-ESR score from baseline to week 24 of 0.538 points.
By comparison, their 128 counterparts who continued with the same glucocorticoid dose experienced a small decrease in their average DAS28-ESR score over the same time frame, of 0.075 points.
Although the between-group difference of 0.613 points was statistically significant in favor of continuing with full glucocorticoid dose, Burmester stressed that it was “small,” noting that almost two-thirds (64.9%) of patients in the tapering group achieved treatment success at week 24, defined as LDA, no RA flares, and no adrenal insufficiency requiring replacement therapy. A total of 77.3% of participants in the glucocorticoid continuation group achieved treatment success.
Burmester said that the safety profile was “similar” whether glucocorticoids were tapered or continued, with serious adverse events reported in a corresponding 3% and 5% of patients. There were no deaths or cases of symptomatic adrenal insufficiency during the study.
And he concluded that “RA patients achieving at least LDA while receiving tocilizumab and long-term [glucocorticoids] at 5 mg/day should be considered for tapering GC dose, ideally targeting discontinuation.”
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