Buttgereit Frank, Palmowski Andriko
Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Joint Bone Spine. 2022 Jan;89(1):105285. doi: 10.1016/j.jbspin.2021.105285. Epub 2021 Oct 1.
Glucocorticoids (GCs) remain regularly used drugs in patients with chronic inflammatory rheumatic diseases. As long-term intake at high dosages is associated with harm, it is generally advised that GCs be tapered and stopped. However, most recommendations concerning tapering have been eminence- or consensus-based. In this narrative review, we present novel data from recent studies (SEMIRA, CORTICOLUP, and GiACTA) shedding light from different angles on the effects of tapering GCs in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and giant cell arteritis (GCA). In RA and SLE, our main findings comprise that (a) the majority of RA and SLE patients can successfully taper their GC, but that (b) tapering increases the risk of flare. In GCA, tocilizumab was shown to be a potent GC-sparing agent. Finally, we also present exemplary tapering schemes for RA, SLE, and GCA, although different tapering regimens have not yet been sufficiently compared in randomized trials.
糖皮质激素（GCs）仍然是慢性炎症性风湿性疾病患者常用的药物。由于高剂量长期服用会带来危害，一般建议逐渐减少并停用GCs。然而，大多数关于逐渐减量的建议都是基于专家意见或共识。在这篇叙述性综述中，我们展示了近期研究（SEMIRA、CORTICOLUP和GiACTA）的新数据，这些数据从不同角度揭示了类风湿关节炎（RA）、系统性红斑狼疮（SLE）和巨细胞动脉炎（GCA）患者逐渐减少GCs用量的效果。在RA和SLE中，我们的主要发现包括：（a）大多数RA和SLE患者可以成功减少GCs用量，但（b）逐渐减量会增加病情复发的风险。在GCA中，托珠单抗被证明是一种有效的糖皮质激素节省剂。最后，我们还给出了RA、SLE和GCA的示例性逐渐减量方案，尽管不同的逐渐减量方案在随机试验中尚未得到充分比较。
