Fewer rheumatic complaints due to low-dose prednisolone

“Prednisolone significantly reduces disease activity and the side effects of the drug are not too bad,” says rheumatologist and professor of Clinical Epidemiology Maarten Boers of Amsterdam UMC.

The results of the 2-year European GLORIA study have been published in Annals of the Rheumatic Diseases, and will be presented on Friday, June 3 at the annual European Congress of Rheumatologists. Boers is pleased with the results. “For years it was thought that you should not give prednisolone for too long due to negative side effects. But our research shows that at this low dose, the benefits outweigh the drawbacks.”

Less medication

The study was a randomized double-blind study. In addition to standard treatment, 451 patients with rheumatism received either a daily dose of 5 mg prednisolone or a placebo for 2 years. The patients on prednisolone had less pain and joint damage, less painful and swollen joints, were not as fatigued and functioned better physically. The standard treatment could be adjusted during the study if the disease flared, but this was needed less often in the prednisolone group than in the placebo group.

More infections

Participants in the prednisolone group were more likely to experience — mainly — mild adverse effects (60%) than those in the placebo group (49%): infections in particular were more common. Bone fractures were rare and slightly more common in the prednisolone group, as were various types of skin complaints. Weight gain was rare and adrenal insufficiency has not been reported.

Revised guideline

Boers says these results prompt a review of existing guidelines for treating RA. “Now the advice is to prescribe only short-term prednisolone, because of the alleged long-term side effects. In practice, however, low-dose prednisolone is often prescribed for a longer period of time. The GLORIA study shows that this can be done in a safe and effective way.” Important conditions for this are accurate monitoring, prevention and treatment of possible side effects.

About the research group

The study participants in both groups hardly differed. They were on average 72 years old, the majority were women, and they had about the same mean disease activity. Most were treated not only for RA, but also for other conditions, such as high blood pressure, for example. On average, the patients used 7 types of drugs. In the prednisolone group, 89% of the patients took the study medication every day. In the placebo group it was 88%, so almost the same. At the start of the study, one third of the patients had osteoporosis. Nearly all patients were prescribed calcium tablets and vitamin D during the study.

–