Low-dose Prednisone in Early Rheumatoid Arthritis

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A new way to dose the same old drug?

This is the second post in a series about modern approaches to the use of prednisone for Rheumatoid Arthritis. Please find the first post, Prednisone Dosage for Rheumatoid Arthritis, here at this link. Does prednisone merely mask symptoms or can it slow Rheumatoid Arthritis disease progression? How low is a so-called “low- dose”? Could there be an even lower dose?

Studying low-dose prednisone with early Rheumatoid Arthritis

The doses of glucocorticoids in the 1950’s caused side effects that were severe enough to scare doctors away from using them to treat Rheumatoid Arthritis. Over the years, the doses of have been reduced. In the last few years, some doctors are reducing them even further, especially with patients who are recently diagnosed.

  • A 2005 editorial in the Journal of Rheumatology called Steroids for Rheumatoid Arthritis: The Honeymoon Revisited states that “Some recent studies suggest that prednisone at 5 mg, 7.5 mg, and 10 mg may initially slow the rate of radiographic progression of RA, although these findings are by no means universal.”
  • One German study on low-dose prednisone found that “a single daily oral dose of 5 mg prednisolone as an adjunct to DMARD therapy decreases radiographic progression in early RA at an acceptable level of risk.”
  • A 2002 article in the Annals of Internal Medicine called Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis concludes “Prednisone, 10 mg/d, provides clinical benefit, particularly in the first 6 months, and substantially inhibits progression of radiologic joint damage in patients with early active rheumatoid arthritis and no previous treatment with disease-modifying antirheumatic drugs.”
  • A Swedish study published late 2005 on low-dose prednisone with early Rheumatoid Arthritis (less than 1 year)concluded that “prednisolone (prednisone) at 7.5 mg/day added to the initial DMARD retarded the progression of radiographic damage after 2 years in patients with early RA, provided a high remission rate, and was well tolerated. Therefore, the data support the use of low-dose prednisolone as an adjunct to DMARDs in early active RA.” (Aside note from me: the prednisone group did statistically better, but the “high remission rate” was still only 55%. And that was by the doctors’ standards. Patients assessments are often more modest.)

Very low-dose prednisone in early Rheumatoid Arthritis

There are many similar articles as doctors around the world are examining whether low doses of prednisone – doses under 10 mg per day – will be effective at both treating symptoms of RA and slowing bone erosions in early Rheumatoid Arthritis. However, one report published this past winter, considers the use of very low-dose prednisone in early Rheumatoid Arthritis. The report titled Efficacy of prednisone 1–4 mg/day in patients with rheumatoid arthritis, asserts that doses even lower than 5 mg may provide some disease modifying effects. The author states, “A few clinicians, including the senior author, have treated most patients over the last decade with an initial dose of 3 mg/day.” Here’s what they found:

“We conclude that this clinical trial documents the efficacy of low-dose prednisone in patients with RA. Although not analysed in this study because of the short time frame, we have observed minimal long-term adverse events in patients who have taken daily prednisone for more than 10 years, sometimes up to 20 years. A multicentre long-term (2 years) ‘de novo’ clinical trial of prednisone in new patients who have not had any prior glucocorticoid treatment would be of considerable value.”

 Would very low doses (< 5mg) be even safer than low doses (< 10mg)?

One German study on low dose prednisone addresses the billion dollar question. “On balance, the safety profile of very low-dose prednisolone therapy established in the controlled trials is not inconsistent with its long-term use. The expected disease-modifying effect has to be weighed against the possibility of side effects, taking the individual patient’s situation into account. It remains to be seen whether dosages lower than 5 mg provide the same benefit with even fewer side effects and whether the same effect can be produced in patients with more advanced disease.”

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Kelly Young. All rights reserved.

This entry was posted on Friday, May 28th, 2010 at 7:08 am and is filed under Treating RA. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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