ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1546

Efficacy and Safety of Corticosteroids in Rheumatoid Arthritis: Systematic Literature Review and Practical Recommendations

Raimon Sanmartí1, Jesús Tornero Molina2, Francisco Javier Narváez3, Alejandro Muñoz4, Elena Garmendia5, Ana M. Ortiz Garcia6, Miguel A. Abad7, Patricia Moya8, Maria Lourdes Mateo9, Delia Reina10, Juan Salvatierra Osorio11, Sergio Rodriguez12, Ana Rubial Escribano13, Natalia Palmou-Fontana14 and Jaime Calvo-Alén15, 1Rheumatology Service, Hospital Clínic de Barcelona, Barcelona, Spain, 2Rheumatology Unit, Hospital de Guadalajara, Guadalajara, Spain, 3Rheumatology Department, Hospital Universitario de Bellvitge, Idibell, Barcelona, Spain, 4Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain, 5Rheumatology, Hospital Universitario Cruces. Barakaldo. Spain, Barakaldo, Spain, 6Rheumatology, Rheumatology Service, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain, 7FEA Reumatología, Hospital Virgen del Puerto, Cáceres, Spain, 8Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 9Rheumatology, Hospital Germans Trias i Pujol, Badalona, Spain, 10Rheumatology, Hospital Moises Broggi, Sant Joan Despí, Spain, 11Complejo Hospitalario Universitario de Granada, Granada, Spain, 12Rheumatology, Hospital Universitario Virgen de Valme, Sevilla, Spain, 13Rheumatology, Hospital Alfredo Espinosa, Urduliz, Spain, 14Hospital Universitario Marqués de Valdecilla, IDIVAL. Universidad of Cantabria, Santander, Spain, 15Rheumatology Department, Hospital Universitario Araba. Vitoria-Gasteiz, Alava, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Date: Monday, October 22, 2018

Title: Rheumatoid Arthritis – Treatments Poster II: PROs, Safety and Comorbidity

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Corticosteroids are effective in rheumatoid arthritis (RA) patients but their adverse events limit their use. The aim of this study was to: 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of corticosteroids in RA; 2) To generate practical recommendations on its use.

Methods:

We performed sensitive systematic literature searches in Medline and Cochrane (up to September 2017), screened EULAR and American College of Rheumatology meeting-abstracts. An expert librarian designed the strategies that included Mesh and text word terms. The search was limited to human RA, adults and the English and Spanish language. The inclusion criteria were as follow: 1) RA patients on corticosteroids; 2) Placebo and an active comparator were accepted as comparators; 3) Articles including typical efficacy and safety variables such as pain, DAS-28, radiographic progression or the infections rate; 4) Only meta-analyses, systematic reviews and clinical trials were selected. Two reviewers screened the titles and abstracts of the retrieved articles independently. They also collected the data from the studies included by using ad hoc standard forms. All collection was double by article and independent. Subsequently, a secondary manual search of the bibliography of the articles that were finally included was performed. Evidence tables were produced. The quality was evaluated with Jadad scale. In a nominal group meeting, based on their results, a panel of experts discusses this evidence and generated practical recommendations. The level of evidence and grade of recommendation was assessed according to the Center for Evidence Based Medicine de Oxford.

Results:

A total of 47 articles were included. Corticosteroids in combination with DMARDs help control disease activity and radiographic progression, especially in the short-medium term and in early RA. Corticosteroids can also improve function and pain. Different types and routes of administration are effective, but there is not a standardized scheme (initial dose, de-escalation and duration of treatment with corticosteroids) superior to others. Adverse events when using corticosteroids are very frequent, dose-dependent although most are mild. Seven recommendations were generated on the use and risk management of corticosteroids (see table).

Conclusion:

These recommendations aim to resolve some common clinical questions and facilitate decision-making with the use of corticosteroids in RA.

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Recommendations

1

In patients with early RA, treatment with corticosteroids in combination with synthetic DMARDs is recommended (NE 1b; GR A)

2

In established RAs it is recommended to individualize the use of corticosteroids as a symptomatic treatment (NE 5; GR D)

3

Corticosteroids are recommended as bridging therapy in early RA, using low doses (≤ 7.5 mg/day of prednisone or equivalent), or medium doses (30 mg/day) following a rapid tapering scheme (NE 1b; GR A)

4

In patients with RA it is recommended to use the lowest effective dose of corticosteroids and to stop them as soon is possible (NE 1b; GR B)

5

When using corticosteroids in patients with RA, it is recommended to rule out comorbidities and risk of infection before their prescription (NE 5; GR D)

6

If corticosteroids are prescribed in the medium to long term, in patients with RA, close monitoring of cardiovascular risk factors and bone mineral density is recommended (NE 5; GR D)

7

If corticoids are prescribed in the medium to long term, in patients with RA, the prophylaxis of osteoporosis induced by corticosteroids is recommended (according to the recommendations of the international guidelines) (NE 5; GR D)

Disclosure: R. Sanmartí, None; J. Tornero Molina, None; F. J. Narváez, None; A. Muñoz, None; E. Garmendia, None; A. M. Ortiz Garcia, None; M. A. Abad, None; P. Moya, None; M. L. Mateo, None; D. Reina, None; J. Salvatierra Osorio, None; S. Rodriguez, None; A. Rubial Escribano, None; N. Palmou-Fontana, None; J. Calvo-Alén, None.

To cite this abstract in AMA style:

Sanmartí R, Tornero Molina J, Narváez FJ, Muñoz A, Garmendia E, Ortiz Garcia AM, Abad MA, Moya P, Mateo ML, Reina D, Salvatierra Osorio J, Rodriguez S, Rubial Escribano A, Palmou-Fontana N, Calvo-Alén J. Efficacy and Safety of Corticosteroids in Rheumatoid Arthritis: Systematic Literature Review and Practical Recommendations [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/efficacy-and-safety-of-corticosteroids-in-rheumatoid-arthritis-systematic-literature-review-and-practical-recommendations/. Accessed .

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