Table 2.

Description of glucocorticoids (GC) tapering strategies. Values are n (%), except where otherwise stated.

Initial daily oral GC dose, mgPrednisolone 60Prednisolone 5–7.5Prednisone 60Prednisolone 60Prednisone 1–4Prednisone 7.5
Taper protocolWeeks 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 rateDecrease to 7.5 mg at 6 weeks; Week 6–28: 7.5 mg daily; Week 29–34: tapered to 0 at an undefined rateDecrease by 1 mg every 4 wks7.5 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 > 2.4NP**“Lack of efficacy” (not defined)NP
Duration of GC taper, wks35Up to 522834164
Successfully tapered GC***71 (92)11 (42)104 (78)NP5 (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.