Tumour necrosis factor-α inhibitors are glucocorticoid-sparing in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease with autoimmune traits of unknown aetiology which primarily affects synovial joints. Glucocorticoids (GCs) are still widely used in RA treatment despite the expanding use of targeted and very efficient agents. The objective of this study was to assess the impact of treatment with tumour necrosis factor-α inhibitors (TNFi) on GC utilization in real-life practice among Danish RA patients.

The DANBIO registry is a nationwide rheumatologic database which collects demographic and clinical data. This retrospective study included RA outpatients from a tertiary rheumatologic department recruited from the DANBIO registry who initiated their first TNFi treatment between January 2000 and February 2010 (n = 171). GC dosing during the year before and the year after TNFi initiation were compared. Patients acted as their own control.

The median daily prednisolone dose was significantly decreased after initiation of TNFi treatment (p < 0.01). At TNFi initiation, 78 patients (46%) received prednisolone compared with 53 (31%) by the end of follow-up. After TNFi initiation, 30 patients (38%) discontinued prednisolone and in 34 (44%) prednisolone dose was reduced. Similarly, the number of GC injections decreased significantly at 13, 26 and 52 weeks following TNFi initiation (p < 0.01).

GC utilization is significantly reduced after initiation of TNFi treatment. Among patients on prednisolone at TNFi onset, prednisolone was withdrawn in one third and the dose was reduced in nearly half. Furthermore, the need for GC injections decreased.