Glucocorticoid sparing effect of tumour necrosis factor alpha inhibitors in rheumatoid arthritis in real life practice.

OBJECTIVE: To determine, in real life practice, the impact of anti-tumour necrosis factor (TNF)-alpha on glucocorticoid (GC) use in rheumatoid arthritis (RA) patients.
METHODS: This systematic monocenter retrospective before-after study enrolled all RA patients who started their first anti-TNF-alpha treatment between January 2004 and December 2006 and were followed more than 3 months after anti-TNF-alpha initiation. Paired comparisons were performed to compare GC intake during the year before anti-TNF-alpha initiation and during the first year of treatment; each patient was his/her own control. Comparisons between patients who reduced their oral prednisone intake and those who did not, were also performed to identify variables associated with prednisone decrease.
RESULTS: 110 patients were included (90 females/20 males, age: 42.1+/-14.4 years, disease duration: 10.6+/-10.2 years). Etanercept was prescribed in 70 (63.6%) patients, adalimumab in 35 (31.8%) and infliximab in 5 (4.6%). At anti-TNF-alpha initiation, 79 patients (71.8%) were taking oral prednisone (mean dose 7.3+/-2.6 mg/d). Of the 82 prednisone-users (74.5% of patients), 62 (75.6%) had lowered prednisone doses, whereas 12 (14.6%) and 10 (12.2%) patients had stable or increased doses, respectively. Twelve patients (15.2%) discontinued oral prednisone. Overall, a significant decrease of 28% of oral prednisone use was observed. The only factors associated with oral prednisone decrease were higher initial prednisone daily doses (p=0.04) and female sex (p=0.04).
CONCLUSION: This study showed a significant GC sparing-effect of anti-TNF-alpha in RA patients in real life practice that was observed for oral, parenteral and intra-articular administration, as early as the first 3 months of treatment.