Patients’ and rheumatologists’ perspectives on the efficacy and safety of low-dose glucocorticoids in rheumatoid arthritis—an international survey within the GLORIA study

Abstract

Objective To evaluate the current perspectives of patients and health professionals regarding the efficacy and safety of low-dose glucocorticoids (GCs) in RA. Methods Two online surveys were disseminated to patients and health professionals, in their native language, through national patient organizations and national rheumatology medical societies, respectively. SurveyMonkey®, MediGuard.org and the Glucocorticoid Low-dose Outcome in RA Study (GLORIA) website were used to offer and deliver these surveys. Results A total of 1221 RA patients with exposure to GCs, and 414 rheumatologists completed the surveys. Patients and rheumatologists reported high levels of agreement regarding the efficacy of low-dose GCs: at least 70% considered that they are very rapid and effective in the control of signs and symptoms of RA. However, half of the patients also reported having suffered serious adverse events with GCs, and 83% described concerns about safety. The majority of rheumatologists estimated that endocrine, ophthalmologic and cutaneous adverse events affect >4% of all patients treated with low-dose GCs for 2 years, based on a heat map. Conclusions RA patients with self-reported exposure to GCs express high levels of satisfaction with low-dose GCs efficacy, as do rheumatologists. However, both expressed excessive concerns regarding the safety of GCs (greatly exceeding the published evidence data), which may compromise the optimal use of this medication. This study indicates that there is an unmet need for appropriately designed prospective trials that shed light on the real risk associated with low-dose GCs, as well as a need for renovated educational programs on the real benefits and harms of low-dose GCs, for both patients and physicians.

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

“…[1][2][3][4][5] GC can not only significantly reduce the inflammation, but also rapidly relieve the articular symptoms in contrast to csDMARDs. [4][5][6] In the recommendations by the European League Against Rheumatism (EULAR) for the management of RA, short-term GC should be considered as a therapy bridging csDMARDs to exhibit efficacy. 2 7 Similarly, short-term GC was recommended in 2015 American College of Rheumatology (ACR) guidelines for both patients with early and established RA with moderate or high disease activity despite of using csDMARDs or biological DMARDs (bDMARDs).…”

“…[9][10][11][12][13] In daily practice, patients with RA and rheumatologists also concerned of the safety of GC therapy. 6 Currently, the 2019 EULAR guidelines underline that GC should be tapered as rapidly as clinically feasible, and ultimately stopped, ideally within 3 months. 2 Nevertheless, there is little evidence to guide clinicians to taper GC, leading to widely variable practice patterns.…”

Low dose, add-on prednisolone in patients with rheumatoid arthritis aged 65+: the pragmatic randomised, double-blind placebo-controlled GLORIA trial

“…Glucocorticoids (GC) were introduced in the 1950s, and chronic low-dose treatment is common in RA, but the balance between benefit and harm is still unclear, especially for chronic low-dose therapy. Meta-analyses show that GC therapy reduces disease activity and slows joint damage progression,2 3 so the debate mostly focuses on harm 4. Most experts agree that long-term GC therapy is harmful, and existing guidelines suggest to avoid or use GC only as ‘bridging’ therapy; however, such opinions are based on observational studies with high potential for bias 5.…”

The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

“…In previous reviews, we have argued that many fears of toxicity with low-dose glucocorticoids were exaggerated and derived from poor-quality observational studies and that most occurred at higher dosages including indications outside of rheumatology. A recent survey within the GLORIA project queried 1221 RA patients and 414 rheumatologists and showed broad satisfaction with the efficacy of low-dose glucocorticoids, but also concerns regarding the frequency of adverse events that were way above what is justified even by the low-quality available evidence [11]. Such fears obviously compromise optimal use of glucocorticoids.…”