Berlin, Germany—Worries about short-term weight gain and increased blood pressure should not be a barrier for RA patients being prescribed low-dose steroids, according to a new European study.
International authors used a pooled analysis of five randomized, controlled trials with 2-year low-dose glucocorticoid treatment interventions allowing concomitant treatment with disease-modifying antirheumatic drugs. The patients were from 12 countries in Europe with early and established RA. The patients were dosed with glucocorticoids at 7.5 mg or less prednisone equivalent per day.
“Coprimary endpoints were differences in change from baseline in body weight and mean arterial pressure after 2 years in intention-to-treat analyses,” according to the report in the Annals of Internal Medicine. “Difference in the change of number of antihypertensive drugs after 2 years was a secondary end point. Subgroup and sensitivity analyses were done to assess the robustness of primary findings.”
The 1,112 participants had a mean age of 61.4 years and 68% were women. “Both groups gained weight in 2 years, but glucocorticoids led, on average, to 1.1 kg (95% CI, 0.4 to 1.8 kg; P <.001) more weight gain than the control treatment,” the researchers advised. “Mean arterial pressure increased by about 2 mm Hg in both groups, with a between-group difference of –0.4 mm Hg (CI, –3.0 to 2.2 mm Hg; P = .187). These results were consistent in sensitivity and subgroup analyses. Most patients did not change the number of antihypertensive drugs, and there was no evidence of differences between groups.”
The study was limited, according to the authors, because body composition was not assessed. It also was not clear whether the results could be generalized to non-European regions, they said.
“This study provides robust evidence that low-dose glucocorticoids, received over 2 years for the treatment of RA, increase weight by about 1 kg but do not increase blood pressure,” the authors concluded.
Background information in the article noted that when steroids were first used to treat RA, they were given in high doses and caused severe adverse effects. Because of that, many experts recommend using newer drugs instead of steroids, according to the report, but less is known about the adverse effects of low-dose steroids, which are popular because they are effective and less expensive.
The authors emphasized that concerns about other adverse effects were not addressed in this study.
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