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 GC | Decrease “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.
↵** Basis for stopping taper not explicitly defined. Remission defined as Disease Activity Score-28 < 2.6.
↵*** 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.