The long-term use of glucocorticoids in patients with chronic inflammatory diseases, such as rheumatoid arthritis, is associated with severe long-term adverse effects, such as cardiovascular disorders, infections, and osteoporosis, according to a new study published in The Lancet.

Glucocorticoids such as cortisone are very effective in controlling inflammatory diseases. However, this type of drug suppresses the adrenal glands, which impairs the body’s ability to produce its own cortisone, according to the study. This can cause fatigue, low blood pressure, and nausea, and can potentially be life-threatening in some cases. 

The study, titled, Steroid Elimination in Rheumatoid Arthritis (SERMIRA), was composed of more than 250 participants across nearly 40 trial centers in 6 different countries. All participants had been receiving glucocorticoids for at least 6 months. 

Patients in the control group continued to receive prednisone at a similar dose for the duration of 6 months, while patients on the dose reduction regimen had their treatment tapered down to 0 over the course of 4 months, according to the study. Both groups received tocilizumab, an anti-interleukin-6 receptor antibody, as an adjunctive therapy. 

Researchers found that treatment prevented disease flare-ups in 77% of the prednisone regimen, compared with 65% in the tapering group. Neither group showed clinically relevant changes in laboratory parameters, disease-related inflammation, or other severe problems, according to the study.

"The fact that glucocorticoid tapering was associated with a treatment success rate of 65 percent is of enormous significance for shared decision-making involving patients. It will now be possible to decide, on a case-by-case basis, whether glucocorticoid treatment should continue or whether tapering should be attempted,” first study author Gerd-Rüdiger Burmester, MD, head of the Medical Department, Division of Rheumatology and Clinical Immunology on Campus Charité Mitte, said in the press release. 

Glucocorticoid tapering should be explored in other clinical settings in which these drugs are used, such as neurology, the researchers said.

Reference:
Reducing corticosteroid use in rheumatoid arthritis (Press Release), Berlin, Germany, July 31, 2020, EurekAlert! Accessed August 17, 2020.