Article Figures & Data
Tables
- Table 1.
Description of randomized trials tapering glucocorticoids (GC) and baseline characteristics of all study participants. All values are n (%), except where otherwise stated.
Boers8 Tengstrand9 Goekoop-Ruiterman10 Choy11 Pincus12 Hickling13 Study design Multicenter, parallel group, double blind, placebo controlled Single center, placebo controlled Multicenter, 4-arm, active controlled, blinded assessor Multicenter, factorial, double blind, placebo controlled Single center, double blind, placebo controlled Multicenter, double blind, placebo controlled No. tapering arms 155 58 508 467 31 75 Age, yrs, mean (SD) 49.5 (12) 61.8* 54.3 (14) 54* 51.5* 49.2 (11) Female 91 (59) 42 (72) 343 (68) 326 (70) 20 (65) 52 (69) Disease duration, wks 16 (median) 484 (mean) 2.3 (median) 16 (mean) 328 (mean) 52 (mean) Prior DMARD 35 (23)** 50 (86)*** 43 (8)** 65 (14) NP 9 (12) Prior anti-TNF NP 1 (1.7)*** NP NP NP NP Prior prednisone use 0 58 (100) 0 NP 31 (100) Yes; exact number of patients not given RF-positive 116 (75) 47 (81) 329 (65) 312 (67) NP 68 (90) Erosions 114 (74) 53 (91) 357 (70) 154 (33) NP 21 (28) Disease activity 4.6 (1.0)† 3.8†# 4.4 (0.9)†† 5.8 (1.3)# 4.5†# NP HAQ-DI 1.5 (0.7) 1.1† 1.4 (0.7) 1.6 (0.7) NP 1.28 (0.7) -
↵* Standard deviation (SD) not provided.
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↵** Study reported only previous treatment with antimalarials.
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↵*** Current use of disease-modifying antirheumatic drugs (DMARD).
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↵† Disease activity score defined as a composite outcome measure containing the Ritchie tender joint index, swollen joint count, erythrocyte sedimentation rate, and the patient’s overall assessment.
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↵†† Disease Activity Score defined by DAS-44.
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↵# Disease Activity Score defined by DAS-28. NP: not provided; RF: rheumatoid factor; TNF: tumor necrosis factor; HAQ-DI: Health Assessment Questionnaire-Damage Index.
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- Table 2.
Description of glucocorticoids (GC) tapering strategies. Values are n (%), except where otherwise stated.
Boers8 Tengstrand9 Goekoop-Ruiterman10 Choy11 Pincus12 Hickling13 Initial daily oral GC dose, mg Prednisolone 60 Prednisolone 5–7.5 Prednisone 60 Prednisolone 60 Prednisone 1–4 Prednisone 7.5 Taper protocol Weeks 1–6: weekly decrease by 20–38% of daily dose
Weeks 7–28: 7.5 mg daily
Week 29–34: 1 day of no GC for 1st week, then 2 days of no GC for 2nd week, etc.
Week 35: No GCDecrease “very slowly” by 2.5 mg in total weekly dose once a week; patients had “permission to go slower if they had withdrawal symptoms” Decrease to 7.5 mg daily over 7 weeks; if DAS44 ≤ 2.4 “persistently,” prednisone tapered to 0 after 28 weeks at undefined rate Decrease to 7.5 mg at 6 weeks; Week 6–28: 7.5 mg daily; Week 29–34: tapered to 0 at an undefined rate Decrease by 1 mg every 4 wks 7.5 mg given every other day for 2 wks, then every third day for 2 wks, then discontinued Basis for stopping taper “Disease flares” (not defined)* “Increasing rheumatic symptoms” DAS44 > 2.4 NP** “Lack of efficacy” (not defined) NP Duration of GC taper, wks 35 Up to 52 28 34 16 4 Successfully tapered GC*** 71 (92) 11 (42) 104 (78) NP 5 (31) 31 (86) -
↵* Disease flare not explicitly defined. Study defined remission using American College of Rheumatology (ACR) preliminary criteria for remission, and the ACR preliminary criteria for improvement in rheumatoid arthritis.
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↵** Basis for stopping taper not explicitly defined. Remission defined as Disease Activity Score-28 < 2.6.
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↵*** Lowest GC dose was 0 mg in all studies, except for Goekoop-Ruiterman, et al10, in which the lowest dose of GC was 7.5 mg daily. NP: not provided in primary study; DAS: Disease Activity Score.
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