Glucocorticoid chronotherapy: a mini-review

Abstract

In this mini-review the chronotherapy with glucocorticoids in rheumatoid arthritis (RA) patients is discussed, as an example of the numerous diseases, showing circadian rhytms in disease activity. Underlying pathophysiological mechanisms are reviewed, explaining the usefullness of glucocorticoid chronotherapy in RA patients. The results of the 2 randomized CAPRA trials, leading to the FDA approval of a modifiedrelease prednisone formula, are discussed, as well as the pricing of these drugs. In a chronopharmacology section it is shown, that some modified drug delivery systems, as MR-prednisone and fast acting meal insulins do not require huge R&D investments.