Does addition of glucocorticoids to the initial therapy influence the later course of the disease in patients with early RA? Results from the Swiss prospective observational registry (SCQM)

Abstract

The main goal of this study was to analyse whether initial addition of glucocorticoid to DMARD therapy influences the long-term course of the disease in patients with early rheumatoid arthritis. All patients from the Swiss RA cohort SCQM with recent-onset arthritis (disease duration ≤1 year) were analysed. The exposure of interest was the use of glucocorticoids (GCs) at baseline. As primary outcome, we considered clinical and radiographic disease progression, assessed by the disease activity (disease activity score, DAS-28), function (health assessment questionnaire disability index, HAQ-DI) and structural joint damage (Ratingen erosion score). The baseline disease characteristics were compared using standard descriptive statistics. The effects of initial GC use on disease progression during follow-up were estimated using linear mixed models with random slope and random intercept, adjusted for potential confounders. In total, 592 patients with early disease were available, with 4.3 years of follow-up (average). Of these, 363 were initially treated with glucocorticoids (GC patients) and 228 were not (no-GC patients). DAS-28 (4.6 vs. 4.3, p = 0.01) and the HAQ-DI (0.94 vs. 0.82, p = 0.01) were higher at baseline in GC patients, while other prognostic factors were balanced at baseline. Neither the change of DAS-28, of HAQ-DI nor of the development of joint erosions differed between the two groups during follow-up. Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p < 0.01). In this cohort, patients with early RA initially treated with GCs had higher measures of disease activity at baseline in comparison to no-GC patients. Despite a similar course of the disease in GC versus non-GC patients, the higher escalation rate to biologic agents in GC patients may reflect a disease less responsive to therapy in these patients. These data suggest that GC use as part of the initial therapeutic strategy in early RA may prevent a more severe course of the disease in patients with higher clinical disease measures at the start of therapy.

Effect of Glucocorticoids on the Clinical and Radiographic Efficacy of Tofacitinib in Patients with Rheumatoid Arthritis: A Posthoc Analysis of Data from 6 Phase III Studies

“…therefore, may not be generalizable to patients starting GC together with csDMARD, implying that caution must be taken when comparing the results from our analysis to other trials in which patients were GC-naive prior to the commencement of the study. Further, it has previously been reported that rheumatologists may be more likely to initiate GC in patients with more severe RA 39 . Although the baseline characteristics of patients in our analysis were generally similar, it is possible that the patients with RA receiving GC were less responsive to treatment than the patients who were not initially receiving GC.…”

A survey of the attitudes, beliefs and knowledge about medical cannabis among primary care providers

“…As a result, software automatically flagging drug interactions cannot assist prescribers. To address this concern, clinicians may stop medical cannabis in order to avoid these interactions when starting new medications, a problem that may be exacerbated in states making available smoked cannabis which contains over 100 phytocannabinoids (i.e., natural plant products) [21]. Although the evidence for significant drug interactions with THC and CBD is rare, THC and CBD are metabolized by CYP1A2, CYP2C9, CYP2C19, and CYP3A4 and serum concentrations of these molecules may theoretically increase with medications that inhibit or induce these enzymes [22].…”

An autumn tale: geriatric rheumatoid arthritis

“…According to Swiss registries, the use of fırst-line CS was significantly higher (25.5% versus 68%) in patients with EORA compared with those with YORA, while the use of biological drugs during follow up was much lower. 49 Genevay and colleagues evaluated 1571 patients with RA (344 over 65 years old) receiving anti-TNFα drugs. 50 Drug withdrawal rates and mean Disease Activity Score (DAS28) score changes were similar in both groups at the end of the second year.…”