title: Tumour necrosis factor-α inhibitors are glucocorticoid-sparing in rheumatoid arthritis.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic disease with autoimmune traits of unknown aetiology which primarily affects synovial joints. Glucocorticoids (GCs) are still widely used in RA treatment despite the expanding use of targeted and very efficient agents. The objective of this study was to assess the impact of treatment with tumour necrosis factor-α inhibitors (TNFi) on GC utilization in real-life practice among Danish RA patients.
  
  
  METHODS
  The DANBIO registry is a nationwide rheumatologic database which collects demographic and clinical data. This retrospective study included RA outpatients from a tertiary rheumatologic department recruited from the DANBIO registry who initiated their first TNFi treatment between January 2000 and February 2010 (n = 171). GC dosing during the year before and the year after TNFi initiation were compared. Patients acted as their own control.
  
  
  RESULTS
  The median daily prednisolone dose was significantly decreased after initiation of TNFi treatment (p < 0.01). At TNFi initiation, 78 patients (46%) received prednisolone compared with 53 (31%) by the end of follow-up. After TNFi initiation, 30 patients (38%) discontinued prednisolone and in 34 (44%) prednisolone dose was reduced. Similarly, the number of GC injections decreased significantly at 13, 26 and 52 weeks following TNFi initiation (p < 0.01).
  
  
  CONCLUSIONS
  GC utilization is significantly reduced after initiation of TNFi treatment. Among patients on prednisolone at TNFi onset, prednisolone was withdrawn in one third and the dose was reduced in nearly half. Furthermore, the need for GC injections decreased.
authors.affiliation: Rheumatology Department C, Odense University Hospital, Denmark. chrinils@hotmail.com
authors.forename: Anna Christine
authors.initials: AC
authors.lastname: Nilsson
authors.forename: Anne Friesgaard
authors.initials: AF
authors.lastname: Christensen
authors.forename: Peter
authors.initials: P
authors.lastname: Junker
authors.forename: Hanne Merete
authors.initials: HM
authors.lastname: Lindegaard
mesh_terms: D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010147:Pain Measurement; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D011241:Prednisone