Glucocorticoid sparing effect of tumour necrosis factor alpha inhibitors in rheumatoid arthritis in real life practice.
OBJECTIVE
To determine, in real life practice, the impact of anti-tumour necrosis factor (TNF)-alpha on glucocorticoid (GC) use in rheumatoid arthritis (RA) patients.


METHODS
This systematic monocenter retrospective before-after study enrolled all RA patients who started their first anti-TNF-alpha treatment between January 2004 and December 2006 and were followed more than 3 months after anti-TNF-alpha initiation. Paired comparisons were performed to compare GC intake during the year before anti-TNF-alpha initiation and during the first year of treatment; each patient was his/her own control. Comparisons between patients who reduced their oral prednisone intake and those who did not, were also performed to identify variables associated with prednisone decrease.


RESULTS
110 patients were included (90 females/20 males, age: 42.1+/-14.4 years, disease duration: 10.6+/-10.2 years). Etanercept was prescribed in 70 (63.6%) patients, adalimumab in 35 (31.8%) and infliximab in 5 (4.6%). At anti-TNF-alpha initiation, 79 patients (71.8%) were taking oral prednisone (mean dose 7.3+/-2.6 mg/d). Of the 82 prednisone-users (74.5% of patients), 62 (75.6%) had lowered prednisone doses, whereas 12 (14.6%) and 10 (12.2%) patients had stable or increased doses, respectively. Twelve patients (15.2%) discontinued oral prednisone. Overall, a significant decrease of 28% of oral prednisone use was observed. The only factors associated with oral prednisone decrease were higher initial prednisone daily doses (p=0.04) and female sex (p=0.04).


CONCLUSIONS
This study showed a significant GC sparing-effect of anti-TNF-alpha in RA patients in real life practice that was observed for oral, parenteral and intra-articular administration, as early as the first 3 months of treatment.
Seror
R
R
Paris Descartes University, Cochin Hospital, France. raphaele.se@gmail.com
Dougados
M
M
Gossec
L
L
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D005938:Glucocorticoids; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D011241:Prednisone