Low-dose Glucocorticoid Treatment in the Patient With RA
Low-dose Glucocorticoid Treatment in the Patient With RA
With increases in the number and mechanisms of action of potent traditional and biologic DMARDs available for the treatment of RA, the goals of treatment have been raised. Thus there is still an unmet need to allow ever more patients to achieve the highest levels of disease control. There is substantial evidence that low-dose GC treatment, when combined with conventional DMARDs, can significantly slow disease progression and increase the number of patients who achieve disease remission. Therefore GCs remain a useful adjunctive treatment for RA and for other systemic inflammatory and autoimmune disorders. Physicians and other health care providers have had concerns about long-term GC treatment because of the well-known adverse events associated with high doses of these drugs. However, adverse events with GCs are dose related and longer-term use of low-dose GCs may still be a viable therapeutic option for some patients.
Multiple approaches have been undertaken to improve the benefit–risk profile for GC treatment in patients with RA, including the development of a delayed-release low-dose prednisone formulation that has shown some clinical benefit. Additional approaches are in earlier stages of development. Optimal use of low-dose GCs has the potential to improve long-term outcomes for patients with RA.
Conclusions
With increases in the number and mechanisms of action of potent traditional and biologic DMARDs available for the treatment of RA, the goals of treatment have been raised. Thus there is still an unmet need to allow ever more patients to achieve the highest levels of disease control. There is substantial evidence that low-dose GC treatment, when combined with conventional DMARDs, can significantly slow disease progression and increase the number of patients who achieve disease remission. Therefore GCs remain a useful adjunctive treatment for RA and for other systemic inflammatory and autoimmune disorders. Physicians and other health care providers have had concerns about long-term GC treatment because of the well-known adverse events associated with high doses of these drugs. However, adverse events with GCs are dose related and longer-term use of low-dose GCs may still be a viable therapeutic option for some patients.
Multiple approaches have been undertaken to improve the benefit–risk profile for GC treatment in patients with RA, including the development of a delayed-release low-dose prednisone formulation that has shown some clinical benefit. Additional approaches are in earlier stages of development. Optimal use of low-dose GCs has the potential to improve long-term outcomes for patients with RA.
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