title: Chronotherapy with modified-release prednisone in patients with rheumatoid arthritis.
abstract: Glucocorticoids are indispensable for the treatment of systemic inflammatory diseases such as rheumatoid arthritis (RA), though their beneficial effects have to be balanced with potential complications arising from high doses, prolonged use or dose splitting. A glucocorticoid formulation (modified-release prednisone) has been developed to be taken in accordance with biological rhythms (chronotherapy). Morning symptoms of RA are caused by elevated nocturnal levels of proinflammatory cytokines, particularly IL-6. Endogenous cortisol levels may be insufficient to counter the inflammatory effects of IL-6. The early morning rise in cortisol can be supplemented with exogenous glucocorticoid replacement therapy if this is given as the recently developed chronotherapy formulation. There is no adverse impact of modified-release prednisone on the hypothalamic-pituitary-adrenal (HPA) axis; indeed, there might be evidence of a beneficial effect on HPA axis function. This review summarizes the development of modified-release prednisone, pharmacokinetic characteristics and clinical experience in patients with RA.
authors.affiliation: Department of Internal Medicine II, Rheumatology, Clinical Immunology & Osteology, Schlosspark-Klinik Teaching Hospital Charité University Medicine Berlin, Heubnerweg 2, 14059 Berlin, Germany. rieke.alten@schlosspark-klinik.de
authors.forename: Rieke
authors.initials: R
authors.lastname: Alten
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy*; D057906:Circadian Clocks; D003692:Delayed-Action Preparations / Q000009:adverse effects / Q000627:therapeutic use; D055870:Drug Chronotherapy; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System; D015850:Interleukin-6 / Q000097:blood; D010913:Pituitary-Adrenal System; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; C508600:IL6 protein, human; D015850:Interleukin-6; D011241:Prednisone; D006854:Hydrocortisone