RA Patients Treated with Tocilizumab-prednisone Combo May Safely Be Tapered Off Glucocorticoid Treatment

A recent study found that some rheumatoid arthritis (RA) patients being treated with tocilizumab and low dose of prednisone may be able to eliminate the prednisone from their treatment plan and still maintain low disease activity (LDA), and patients may have even better results if they maintain 5 mg/day of prednisone. 

Researchers randomized 259 patients to glucocorticoid (GC)-taper or GC5mg; in each group, 114 and 112 patients, respectively, completed 24 weeks of treatment. Mean disease duration was 9.2 years. The primary outcome was mean change in disease activity score 28 with erythrocyte sedimentation rate (DAS28-ESR) at the end of the study period; treatment success was the secondary outcome, which researchers defined as DAS28-ESR ≤3.2 at the end of the study period, no flareups during the study period, and no replacement therapy due to adrenal insufficiency. At the start of the study, mean DAS28-ESR was 1.9. 

By the end of the 24 weeks, the GCtaper group’s prednisone dosage was 0 mg, and the DAS29-ESR increased by 0.538, versus a decrease of 0.075 for the GC5mg group. Thirty-four (26%) GCtaper patients experienced a flare, compared to 14 (10.9%) GC5mg patients. Mean time to first flare in the GCtaper and GC5mg patients was 15.64 weeks and 12.11 weeks, respectively. 

In both groups, the majority of patients achieved treatment success (GCtaper: 64.9%, n = 85; GC5mg: 77.3%, n = 99). No deaths or cases of symptomatic adrenal insufficiency occurred; 3% of the GCtaper patients and 5% of the GC5mg patients experienced adverse events. 

The study’s findings were presented at the American College of Rheumatology’s annual meeting. 

“Together these results suggest that all pts achieving LDA or remission with [tocilizumab] who are receiving long-term low-dose GC should be considered for GC tapering, ideally targeting discontinuation,” the study authors wrote. 

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SourcesRheumatology News, 2018 ACR/ARHP Annual Meeting abstracts