Residual Glucocorticoid Use at Boolean Remission in Rheumatoid Arthritis: An analysis of the FRANK Registry

Glucocorticoids (GCs) are recommended as short-term bridging therapy in rheumatoid arthritis (RA), yet many patients continue long-term GC use, raising safety concerns. This study evaluated the effectiveness and safety of residual GC use at the time of achieving Boolean remission.

Data were obtained from the Fukuoka Rheumatoid Arthritis Network (FRANK) registry, a multicentre prospective registry. We included 411 patients who newly achieved Boolean remission between 2018 and 2023. Patients were classified as GC non-users or users based on concomitant oral GC use at remission. Propensity score-based inverse probability of treatment weighting (IPTW) was adjusted for baseline confounders. The primary outcome was time to loss of Boolean remission. Secondary outcomes included longitudinal changes in the Clinical Disease Activity Index (CDAI), modified Health Assessment Questionnaire (mHAQ), and EuroQol 5-dimension (EQ-5D) scores. Safety outcomes included the incidence of herpes zoster, acute coronary syndrome, and stroke.

After IPTW adjustment, baseline characteristics were well balanced between 281 GC non-users and 130 GC users. No significant difference was observed in the time to loss of remission. Longitudinal trajectories of CDAI, mHAQ, and EQ-5D scores were comparable between groups. Although the very low number of events precludes definitive conclusions, safety events were numerically higher in GC users.

Residual GC use at remission did not improve remission maintenance. Given the lack of additional clinical benefit and the numerical trend toward higher safety events, GC-free remission is the true therapeutic goal, highlighting the need to overcome reliance on GCs through active tapering and discontinuation.