Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trial

Burmester, Gerd R.; Buttgereit, Frank; Bernasconi, Corrado; Álvaro‐Gracia, José María; Castro, Nidia; Dougados, Maxime; Gabay, Cem; Laar, Jacob M van; Nebesky, J. Michael; Pethoe-Schramm, Attila; Salvarani, Carlo; Donath, Marc Y.; John, Markus R.; Constantin, Arnaud; Gottenberg, Jacques Éric; Loiseau-Pérès, Sylvie; Nguyen, Minh Vu Chuong; Schaeverbeke, Thierry; Alten, Rieke; Amberger, C.; Biewer, W; Boche, Konrad; Engel, Andreas K.; Feuchtenberger, Martin; Fleck, Martin; Gauler, Georg; Heilig, B.; Höhle, M.; Iking‐Konert, Christof; Kästner, Peter; Kofler, David M.; Krueger, Klaus; Kühne, C; Kurthen, Reiner; Schulze‐Koops, Hendrik; Schwenke, Holger; Sieburg, Maren; Specker, Christof; Tony, Hans‐Peter; Wassenberg, Siegfried; Wendler, Jörg; Caporali, Roberto; Epis, Oscar Massimiliano; Matucci‐Cerinic, Marco; Дубиков, А. Н.; Камалова, Р Г; Korolev, Maxim Aleksandrovich; Мазуров, В. И.; Puntus, Ekaterina; Damjanov, Nemanja; Ilić, Tamara; Lazarevic, M.; Milenković, Saša; Petronijević, Milan; Bouajina, Elyes; Elleuch, M.

doi:10.1016/s0140-6736(20)30636-x

Cited by 99 publications

(82 citation statements)

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“…4 In the absence of any data for PsA, Wei et al may be referred to the EULAR RA management recommendations 9 for a potential orientation, given that in RA tapering schedules have been studied. 10 Tapering should be further investigated in PsA. The last point regards elderly patients and we agree with the authors that research is warranted on the management of elderly patients with PsA.…”

Section: Al' By Wei Et Alsupporting

confidence: 62%

Response to: ‘Comment on: ‘EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update’ by Gossecet al’ by Weiet al

et al. 2020

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Section: Al' By Wei Et Alsupporting

confidence: 62%

Response to: ‘Comment on: ‘EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update’ by Gossecet al’ by Weiet al

et al. 2020

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“…2 7 Previous clinical investigations have evaluated the feasibility of GC discontinuation by introducing the bDMARD or tofacitinib. [27][28][29][30][31][32] For example, Inoue et al analysed 80 patients with RA taking a median PSL dose of 5.0 (1.0-10.0) mg/day at bDMARDs initiation. 31 Over a median follow-up of 33.1 months, 31.3% of participants discontinued GC.…”

Section: Discussionmentioning

confidence: 99%

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

Xie

Hao

et al. 2021

Ann Rheum Dis

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ObjectiveTo unravel the dynamical trajectory and features of glucocorticoids (GC) tapering and discontinuation in patients with rheumatoid arthritis (RA) commencing GC with concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).MethodsWe used data from longitudinal real-world Treat-to-TARget in RA cohort. Patients with RA who started GC and contaminant csDMARDs therapy were included. The changes in GC dose and disease activity were evaluated. GC discontinuation rate was analysed using Kaplan-Meier analysis. The relapse profile within 6 months after GC discontinuation was also analysed.ResultsA total of 207 patients with RA were included. During a median follow-up of 38.6 months, 124 patients discontinued GC. The median prednisolone dose of 10 (5–10) mg/day at initiation was reduced by 50% in the first 6 months and then more slowly, to zero by 48 months eventually. The cumulative probabilities of GC discontinuation were 9.7%, 26.6%, 48.0% and 58.6% at month 6, years 1, 2 and 3, with calculated median time to GC cessation of 27 months. In 110 DMARD-naïve patients, the corresponding cumulative probabilities of GC discontinuation were, respectively, 12.7%, 30.0%, 50.9% and 60.6%, with calculated median time to GC cessation of 24 months. Of the 124 patients who discontinued GC, adding other csDMARDs or concomitant csDMARDs increment was documented in 28.2% of them. Approximately half of 124 patients were in clinical remission at GC discontinuation. Within 6 months after GC withdrawal, 79.1% (91/115) of patients maintained relapse free.ConclusionsIn patients with RA commencing GC besides csDMARDs, GC is feasibly discontinued with favourable control of disease activity in real-life setting, mostly without short-term flare. But the withdrawal time is far from reaching the recommended time frame, indicating the gap between real-world practice and current guidelines.

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“…GC co-prescribed with csDMARDs and combinations of csDMARDs are more intensive than csDMARD monotherapy, so the negative relationship between these therapies and remission might reflect the choice of treatment based on disease severity according to clinical practice and prospective randomized trials. [ 29 , 30 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region

Sun

Cai

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: Clinical remission is an attainable goal for Rheumatoid Arthritis (RA). However, data on RA remission rates from multinational studies in the Asia-Pacific region are limited. We conducted a crosssectional multicentric study to evaluate the clinical remission status and the related factors in RA patients in the Asia-Pacific region. Methods: RA patients receiving standard care were enrolled consecutively from 17 sites in 11 countries from APLAR RA SIG group. Data were collected on-site by rheumatologists with a standardized casereport form. Remission was analyzed by different definitions including disease activity score using 28 joints (DAS28) based on ESR and CRP, clinical disease activity index (CDAI), simplified disease activity index (SDAI), Boolean remission definition, and clinical deep remission (CliDR). Logistic regression was used to determine related factors of remission. Findings: A total of 2010 RA patients was included in the study, the overall remission rates were 62 • 3% (DAS28-CRP), 35 • 5% (DAS28-ESR), 30 • 8% (CDAI), 26 • 5% (SDAI), 24 • 7% (Boolean), and 17 • 1% (CliDR), respectively, and varied from countries to countries in the Asia-Pacific region. Biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) prescription rate was low (17 • 9%). Compared to patients in non-remission, patients in remission had higher rates of b/tsDMARDs usage and lower rates of

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Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trial

Cited by 99 publications

References 30 publications

Response to: ‘Comment on: ‘EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update’ by Gossecet al’ by Weiet al

Response to: ‘Comment on: ‘EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update’ by Gossecet al’ by Weiet al

Dynamical trajectory of glucocorticoids tapering and discontinuation in patients with rheumatoid arthritis commencing glucocorticoids with csDMARDs: a real-world data from 2009 to 2020

Clinical remission of rheumatoid arthritis in a multicenter real-world study in Asia-Pacific region

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