Safety of medium- to long-term glucocorticoid therapy in rheumatoid arthritis: a meta-analysis.
OBJECTIVE
Several randomized controlled trials (RCTs) and meta-analyses have confirmed clinical efficacy of glucocorticoids in RA. Concerns regarding safety associated with medium- to long-term use in RA have limited their use in clinical practice. In this meta-analysis, we assessed the toxicity related to medium- to long-term (defined as 1 year or longer) glucocorticoid therapy in RA.


METHODS
MEDLINE, EMBASE and CINAHL databases were searched for RCTs of glucocorticoids in RA. RCTs fulfilling the following criteria were included: double-blinded, placebo-controlled, lasted 1 year or longer, used prednisolone (or equivalent) and in English. Toxicity was assessed by number of the patients withdrawn for adverse events (AEs), and the numbers of serious adverse events (SAEs) and AEs. RCTs were compared by meta-analysis using odd ratios (OR) with 95% CIs.


RESULTS
Six RCTs with total of 689 patients met the inclusion criteria. All RCTs lasted >or=2 years. All studies allowed concomitant use of NSAIDs and DMARDs. Toxicity of glucocorticoid therapy based on number of patients withdrawn was limited (OR = 1.09; 95% CI 0.52, 2.25). Using number of AEs per patient-year (OR = 1.19; 95% CI 0.91, 1.57) and SAEs (OR = 1.06; 95% CI 0.67, 1.67) produced similar results. Efficacy/toxicity ratio was good for glucocorticoid therapy (number needed to harm/number needed to treat = 0.25).


CONCLUSIONS
Medium- to long-term glucocorticoid therapy in RA is associated with limited toxicity compared to placebo.
Ravindran
Vinod
V
Academic Department of Rheumatology, Sir Alfred Baring Garrod Clinical Trials Unit, Weston Education Centre, King's College London, London, UK. drvinod12@gmail.com
Rachapalli
Satish
S
Choy
Ernest H
EH
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016017:Odds Ratio; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012449:Safety; D016896:Treatment Outcome
D005938:Glucocorticoids; D011239:Prednisolone