Division of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
Clin Exp Rheumatol. 2013 Jul-Aug;31(4 Suppl 78):S9-13. Epub 2013 Oct 3.
In rheumatoid arthritis (RA), low-dose glucocorticoid (GC) therapy has a well-established effect on disease activity. Particularly in early RA, robust evidence demonstrates that GC treatment in association with standard disease-modifying anti-rheumatic drugs (DMARDs) is effective in inducing high remission rates, earlier and more persistently. Despite international recommendations that discourage long-term concomitant GC use, the majority of the clinical trials and observational registries on biologic agents include a high proportion (up to 80%) of patients in treatment with GC. From an analysis of the literature, a substantial lack of reliable information about the efficacy of GC in association with biologic agents emerges; in particular, the role of GC co-therapy in sustaining remission after biological therapy discontinuation remains to be clarified. Given the increasing prevalence of patients in sustained remission, a rational discontinuation strategy should include low-dose GCs in the experimental design to elucidate their role in inducing and maintaining biologic-free remission, for efficacy, safety and pharmacoeconomic considerations.
在类风湿关节炎 (RA) 中，低剂量糖皮质激素 (GC) 治疗对疾病活动具有明确的疗效。特别是在早期 RA 中，强有力的证据表明，GC 联合标准的疾病修饰抗风湿药物 (DMARDs) 治疗可有效诱导高缓解率，且更早、更持久。尽管国际建议不鼓励长期同时使用 GC，但大多数关于生物制剂的临床试验和观察性登记研究中，接受 GC 治疗的患者比例较高（高达 80%）。从文献分析中可以看出，关于 GC 与生物制剂联合使用的疗效的可靠信息严重缺乏；特别是 GC 辅助治疗在生物治疗停药后维持缓解的作用仍有待阐明。鉴于持续缓解的患者比例不断增加，合理的停药策略应在实验设计中包含低剂量 GC，以阐明其在诱导和维持无生物制剂缓解方面的作用，从疗效、安全性和药物经济学方面考虑。
