Tapering Off Steroids

People with moderate-to-severe rheumatoid arthritis (RA) often need to take a biologic drug as well as a glucocorticoid in order to get their disease activity under control. But of course patients don’t want to take drugs they don’t absolutely require, either. Can people with RA taking the biologic drug tocilizumab (Actemra) and the glucocorticoid prednisone safely ditch the prednisone once they meet the criteria for low disease activity?

According to a new study, presented at the European Congress of Rheumatology (EULAR) in Madrid, it’s possible — at least for some patients. The study, a randomized, controlled trial, followed 259 patients who had reached remission or low disease activity while taking a combination of Actemra and prednisone. Over the course of 24 weeks, one group of patients continued both drugs while the other slowly tapered off prednisone until they were no longer using it.

About two-thirds of patients who had stopped using prednisone had “high levels of treatment success,” according to a statement from EULAR. The authors concluded that sticking with prednisone provided better disease activity control compared to tapering off it, but that the overall difference in disease activity scores (DAS28-ESR) in both the taper and non-taper groups was similar.

“The results suggest that all patients achieving [low disease activity] or remission with [tocilizumab] and receiving long-term low-dose [glucocorticoids] should be considered for… tapering, ideally targeting discontinuation,” the authors wrote.

“On the basis of our results, we believe that all patients achieving low disease activity or remission with tocilizumab should be offered glucocorticoid tapering,” study co-author Gerd R. Burmester, MD, told EULAR.

All drugs, including Actemra — an interleukin 6 (IL-6) inhibitor — have side effects, but patients tend to especially dislike taking gluticorticoids like prednisone. Glucocorticoids are a type of steroid medication, and they often cause bothersome side effects including weight gain, acne, dizziness, and insomnia, as well as raise the risk of longer-term health problems like osteoporosis and diabetes.

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