During 2 years of low-dose glucocorticoid therapy for rheumatoid arthritis (RA) in 5 randomized controlled trials, patient weight increased by a modest average of 1 kg, but blood pressure was only slightly elevated, researchers report. The authors write: “Guidelines advise against long-term low-dose glucocorticoid use not because of lack of efficacy—glucocorticoids have an effect on disease activity and radiographic progression even at a low dose and the risk for flare is lower in patients continuing low-dose glucocorticoids versus those withdrawing them —but because of a fear of [adverse effects (AEs)]. However, although it is beyond doubt that medium-to-high dose glucocorticoids can cause various serious and nonserious AEs, the evidence for toxicity of low-dose glucocorticoids is much less clear.”
Studies included in the pooled analysis used prednisone or prednisone equivalents of 7.5 mg per day in patients with early or established RA. Based on coprimary endpoints of the differences in change from baseline in body weight and mean arterial pressure after 2 years, the authors found the following: “A total of 1,112 participants were included (mean age, 61.4 years [SD, 14.5]; 68% 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 < 0.001) more weight gain than the control treatment. 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 = 0.187). 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.”