Past Coverage of EULAR 2016Past Coverage of EULAR 2016 Return To RheumReports Home

 

Can Long-term Use of Glucocorticoids Shift the Benefit-Risk Ratio in Rheumatic Diseases?

June 9 2016 12:44 AM ET via RheumReports RheumReports

Franc Buttgereit answered this question during the clinical science session Wednesday at EULAR. His presentation focused on data available from the RA literature. He highlighted the importance of identifying the cut-offs of glucocorticoids (GCs) that shift the balance from benefit to harm.

GCs reduce inflammation and disease activity and in the RA data presented from Germany, up to 50% of patients were on GCs. The EULAR 2013 update highlighted the use of GC as bridging therapy in the management of RA. Svensson et al. (Arthritis Rheum 2005) reported that GC at low dosages could be used for up to 2 years. Others have proposed that GCs can be used as maintenance (1-5 mg/d) indefinitely because of their ability to improve long-term outcomes in RA patients.

In the recent EULAR Task force 2016, osteoporosis, glucose intolerance, infections and hypertension were listed as the four most common complications of GC therapy. The most important points to remember from this EULAR recommendation are the following: 

  1. The importance to distinguish between different cut-offs of GCs (<5, 5-10 and >10 mg/d) 

  2. Risk of harm for the majority of patients is low at dosages <5 mg/d but elevated at dosages >10 mg/day with long-term use (defined as 3-6 months or longer) 

  3. The level of harm depends on GC dosage and patient-specific factors. In the group of patients receiving GC between 5-10 mg/d, the risk of harm or benefit from long-term use of GCs depended on the presence of risk factors and patient-specific preventive measures.

The EULAR recommendations proposed a list of risk factors and protective factors for each of the most commonly encountered complications of GCs. For osteoporosis, the list of risk factors included older age, smoking, high alcohol intake and others. The list of protective factors included vitamin D, exercise, bisphosphonates, SERMs and others.

The bottom line is that decisions on the use of GCs - and dosages - should be patient-specific. An individualized approach should be based on the presence of either protective and/or provocative risk factors that could either decrease or increase the risk of GC complications.


Share This Report


About the Author

Dr. Zahi Touma
Dr. Zahi Touma

Dr. Touma is a clinical epidemiologist and an Assistant Professor of Medicine in the Division of Rheumatology at the University of Toronto, and Staff Physician and Clinician Scientist in the Division of Rheumatology, Toronto Western Hospital and Mount Sinai Hospital. In 2012 he completed his PhD in Clinical Epidemiology and subsequently completed one year of post-doctoral work in Measurement in Clinical Research.

View Full Bio

Trending Reports From EULAR 2016