‘Excessive concerns’ about the safety of low-dose glucocorticoids
medwireNews: Rheumatologists and patients with rheumatoid arthritis (RA) have concerns about the safety of low-dose glucocorticoids that “greatly exceed” evidence from published data, researchers report.
These findings are based on an international survey of 414 rheumatologists and 1221 glucocorticoid-exposed RA patients with an average daily dose of 5 mg prednisolone equivalent over the previous year. Respondents reported “high levels of satisfaction” with the efficacy of low-dose glucocorticoids (≤7.5 mg/day), with 75% of rheumatologists and 73% of patients reporting they were “very effective.”
However, when asked about treatment safety (with different phrasing of questions in different countries due to regulatory requirements), 47% of patients said they had experienced serious adverse events (AEs) due to glucocorticoids, and 83% of 140 patients from the USA said they were concerned about experiencing serious AEs. A substantial proportion of rheumatologists estimated that endocrine, ophthalmologic, and cutaneous AEs would affect more than 4% of patients treated with low-dose prednisolone for 2 years.
These concerns are not supported by the currently available data, indicating that they are “excessive” and “can jeopardize the optimum use of this therapy,” say Tânia Santiago (University of Coimbra, Portugal) and colleagues from the GLORIA study.
They conclude in Rheumatology that “there is an unmet need for appropriately designed prospective trials that shed light on the real risk associated with low-dose [glucocorticoids].”
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