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Alten R, Holt R, Grahn A, Rice P, Kent J, Buttgereit F, Gibofsky A. Morning stiffness response with delayed-release prednisone after ineffective course of immediate-release prednisone. Scand J Rheumatol 2015; 44:354-8. [PMID: 26114379 PMCID: PMC4732433 DOI: 10.3109/03009742.2015.1038582] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: To assess morning stiffness in rheumatoid arthritis (RA) patients switched from immediate-release (IR) to delayed-release (DR) prednisone. Method: Circadian Administration of Prednisone in Rheumatoid Arthritis-1 (CAPRA-1) is a 12-week, randomized, multicentre, active-controlled study of morning stiffness that consisted of a double-blind phase and a 9-month open-label extension. Patients receiving IR prednisone with no significant improvement after the double-blind study were switched to DR prednisone. Morning stiffness duration and median absolute and relative changes in pain and global assessment were evaluated (3, 6, and 9 months). Results: In patients switched from IR to DR prednisone (n = 110), statistically significant reductions in morning stiffness occurred over 3 months and were sustained for 9 months. Absolute reduction of morning stiffness was ~50 min with > 40% relative reduction at each visit. Interleukin (IL)-6 levels were reduced by the same amount. Statistically significant and clinically meaningful mean reductions in morning stiffness were maintained at > 67 min at each visit along with significant improvements in pain and patient global assessment. There was no evidence of tachyphylaxis seen over the 9-month study. Conclusions: Patients receiving disease-modifying anti-rheumatic drugs (DMARDs) and IR prednisone who had not had significant reductions in morning stiffness demonstrated statistically significant and clinically meaningful improvements when switched to DR prednisone.
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Buttgereit F, Strand V, Lee E, McCabe D, Kolluri S, Tammara B, Rojo R, Hey-Hadavi J. SAT0221 Efficacy and Safety of PF-04171327, a Novel Dissociated Agonist of the Glucocorticoid Receptor (DAGR): Results of a Phase 2, Randomized, Double-Blind Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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53
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Gaber T, Hahne M, Strehl C, Hoff P, Dörffel Y, Feist E, Burmester GR, Buttgereit F. FRI0185 Impact of Tocilizumab on Neutrophil Survival and Function. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alten R, Grahn A, Rice P, Holt R, Buttgereit F. AB0507 Response of Patient Reported Symptoms of Stiffness and Pain During the Day from Adding Low-Dose Delayed-Release (DR) Prednisone to Stable Dmard Therapy Over 12 Weeks in Patients with Moderate Rheumatoid Arthritis (RA). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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55
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Buttgereit F. SP0097 What is New: Osteoporosis & Bone Diseases. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fügener S, Lang A, Gaber T, Burmester GR, Buttgereit F, Hoff P. THU0166 Logistic Regression Method Identifies RA as Risk Factors for Delayed Fracture-Healing – an Update of a Single-Center Retrospective Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Boeth H, Duda G, Hinzmann D, Hermann S, Taylor W, Ehrig R, Witaschek T, Buttgereit F. FRI0040 A Novel Approach to Quantify Morning Stiffness in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strehl C, Bijlsma J, De Wit M, Cutolo M, Sereor R, Winthrop K, Buttgereit F. SAT0224 Defining the Conditions Under Which Different Glucocorticoid Doses Have a Good Benefit-Risk Ratio. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Buttgereit F. SP0157 Glucocorticoids: How to Achieve a Good Benefit: Risk Balance Using this Double Edged Sword. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kunath P, Hahne M, Mursell M, Strehl C, Burmester GR, Buttgereit F, Gaber T. AB0144 The Distinct and Overlapping Functions of Hypoxia Inducible Factors in the Adaption Process of Human Microvascular Endothelial Cells to Hypoxia. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Santiago T, Jacobs JW, Saag KG, Buttgereit F, Pereira da Silva JA. Balancing the benefits and risks of low-dose glucocorticoid in rheumatoid arthritis. ACTA REUMATOLOGICA PORTUGUESA 2015; 40:10-22. [PMID: 25844966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Glucocorticoids have potent anti-inflammatory and immunomodulatory effects and are widely use in the management of rheumatoid arthritis in combination with other synthetic and with biological disease-modifying anti-rheumatic drugs. Concerns about the risk of adverse effects of glucocorticoids, especially if they are given at higher dosages and for a longer time, hamper their use despite the clear symptomatic and disease modifying benefits. However, the evidence base for these concerns for low dose glucocorticoid therapy is quite limited due to the scarcity of quality literature on its safety in rheumatoid arthritis. This review discusses the current understanding about their disease-modifying effects, toxicity data from recent trials and observational studies, recommendations for their management and the current efforts to improve the therapeutic ratio of glucocorticoid through the development of new formulations, such as modified-release prednisone.
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Buttgereit F, Kent J, Holt R, Grahn A, Rice P, Alten R, Yazici Y. AB0426 Time to Event Analysis of Patient Reported Morning Stiffness Where Delayed-Release (DR) Prednisone Was Compared To, and Replaced, Immediate Release Prednisone in Rheumatoid Arthritis (RA) Patients Receiving DMARDS over 1 Year. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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63
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Lang A, Neuhaus J, Pfeiffenberger M, Gaber T, Ponomarev I, Buttgereit F, Barnewitz D, Schmidt M. AB0092 Controlled Expression of Endogenous Interleukin-4 for Gene Therapeutic Approaches towards Rheumatic Disorders. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Strehl C, Gaber T, Jakstadt M, Hahne M, Hoff P, Maurizi L, Hofmann H, Burmester GR, Buttgereit F. THU0119 Impact of Amino-Pva Coated Nanoparticles on Viability and Cytokine Secretion of Human Immune Cells Obtained from Healthy Donors and Patients with Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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65
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Fuegener S, Hoff P, Lang A, Gaber T, Rakow A, Simon P, Burmester GR, Perka C, Buttgereit F. SAT0090 Analysis of Potential Risk Factors for Delayed Fracture-Healing. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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66
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Schönbeck K, Tran C, Strehl C, Gaber T, Jakstadt M, Röhner E, Burmester G, Buttgereit F, Hoff P. SAT0564 Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) Expressed in Human Mesenchymal Stromal Cells. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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67
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Lang A, Schmidt-Bleek K, Jackstadt M, Gaber T, Duda G, Buttgereit F. SAT0548 Impact of Glucocorticoids on Mesenchymal Stromal Cell Differentiation - Can Hypoxia Counteract? Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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68
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Buttgereit F. SP0152 Novel Glucocorticoids and Glucocorticoid Receptor Ligands: Teaching Old Drugs New Tricks. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.6255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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69
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Buttgereit F. SP0132 How to Assess Glucocorticoid Confounding in the Context of Osteoporosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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70
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Spies C, Gaber T, Hoff P, Mazuch J, Maier B, Hahne M, Strehl C, Tran C, Soboleva N, Stoehr A, Wagegg M, Fangradt M, Jakstadt M, Huscher D, Burmester GR, Detert J, Kramer A, Buttgereit F. OP0086 Alterations of immune cellular circadian rhythms in rheumatoid arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.1769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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71
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Duru N, van der Goes MC, Jacobs JWG, Andrews T, Boers M, Buttgereit F, Caeyers N, Cutolo M, Halliday S, Da Silva JAP, Kirwan JR, Ray D, Rovensky J, Severijns G, Westhovens R, Bijlsma JWJ. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2013; 72:1905-13. [PMID: 23873876 DOI: 10.1136/annrheumdis-2013-203249] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To develop recommendations for the management of medium to high-dose (ie, >7.5 mg but ≤100 mg prednisone equivalent daily) systemic glucocorticoid (GC) therapy in rheumatic diseases. A multidisciplinary EULAR task force was formed, including rheumatic patients. After discussing the results of a general initial search on risks of GC therapy, each participant contributed 10 propositions on key clinical topics concerning the safe use of medium to high-dose GCs. The final recommendations were selected via a Delphi consensus approach. A systematic literature search of PubMed, EMBASE and Cochrane Library was used to identify evidence concerning each of the propositions. The strength of recommendation was given according to research evidence, clinical expertise and patient preference. The 10 propositions regarded patient education and informing general practitioners, preventive measures for osteoporosis, optimal GC starting dosages, risk-benefit ratio of GC treatment, GC sparing therapy, screening for comorbidity, and monitoring for adverse effects. In general, evidence supporting the recommendations proved to be surprisingly weak. One of the recommendations was rejected, because of conflicting literature data. Nine final recommendations for the management of medium to high-dose systemic GC therapy in rheumatic diseases were selected and evaluated with their strengths of recommendations. Robust evidence was often lacking; a research agenda was created.
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Fangradt M, Gaber T, Hahne M, Strehl C, Jakstadt M, Hoff P, Burmester GR, Buttgereit F. AB0065 Adaptation of human monocytes and macrophages to hypoxia. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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73
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Spies CM, Wiebe E, Tu JW, Gaber T, Huscher D, Seibel M, Zhou H, Buttgereit F. AB0085 Murine antigen-induced arthritis is not affected by transgenic disruption of osteoblastic glucocorticoid signaling. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gaber T, Tran CL, Schellmann S, Hahne M, Strehl C, Jakstadt M, Burmester GR, Buttgereit F. AB0026 Pathophysiological hypoxia affects both redox state and il-2 signaling of human cd4+ t cells and concomitantly impairs survival and proliferation. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hahne M, Strehl C, Jakstadt M, Hoff P, Gaber T, Burmester GR, Buttgereit F. THU0022 The Role of HIF-1 and HIF-2 During Angiogenesis and Metabolic Adaptation of Human Microvascular Endothelial Cells Towards Hypoxia. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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