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In the era of disease-modifying antirheumatic drugs, how close are we to treating rheumatoid arthritis without the use of glucocorticoids?

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Abstract

We wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of ≤ 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25–116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of ≥ 7.5 mg/day was found to be crucial in not reaching the GC target dose (p < 0.001, OR 39.0 (24.1–63.2)). The initial GC dose of ≥ 7.5 mg/day, female gender, age, RF positivity, high DAS28, and VAS pain level were all highly related for GC continuation. Despite the use of DMARDs, our data revealed that we are still far from achieving our goal of treating RA without using steroids.

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The datasets are available from the corresponding author on reasonable request.

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Acknowledgements

Authors are thankful to Abbvie, Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB

Funding

Hacettepe Rheumatology Association (HRD) and Hacettepe Financial Enterprises.

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey

    Burcu Yagiz, Belkis Nihan Coskun, Yavuz Pehlivan & Ediz Dalkilic

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Sedat Kiraz, Ertugrul Cagri Bolek, Emre Bilgin, Omer Karadag, Ihsan Ertenli & Umut Kalyoncu

  3. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Veli Yazisiz

  4. Unit of Rheumatology, Ankara City Hospital, Ankara, Turkey

    Orhan Kucuksahin & Abdulsamet Erden

  5. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Koç University, İstanbul, Turkey

    Nilufer Alpay Kanitez

  6. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey

    Gezmiş Kimyon

  7. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey

    Hakan Emmungil

  8. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey

    Sule Yasar Bilge & Timucin Kasifoglu

  9. Unit of Rheumatology, Basaksehir Çam Ve Sakura City Hospital, İstanbul, Turkey

    Cemal Bes

  10. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazıg, Turkey

    Ahmet Karatas

  11. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey

    Bahar Kelesoglu

  12. Unit of Rheumatology, Adana Numune Training and Research Hospital, Adana, Turkey

    Duygu Ersozlu

  13. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey

    Emel Orge Gonullu

  14. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey

    Ridvan Mercan

  15. Department of Internal Medicine, Division of Rheumatology, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey

    Sedat Yilmaz

  16. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey

    Servet Akar

Authors
  1. Burcu Yagiz
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  2. Belkis Nihan Coskun
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  3. Yavuz Pehlivan
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  4. Ediz Dalkilic
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  5. Sedat Kiraz
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  14. Cemal Bes
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  15. Ertugrul Cagri Bolek
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  18. Bahar Kelesoglu
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  19. Duygu Ersozlu
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  21. Ridvan Mercan
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  23. Omer Karadag
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  25. Ihsan Ertenli
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Corresponding author

Correspondence to Burcu Yagiz.

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Conflict of ınterest

UK received honorary from Abbvie, Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB. YP received honorary from Abbvie, Roche, Novartis, MSD, Pfizer. TK received honorary from Abbvie, Amgen, MSD, Novartis, Pfizer, Roche, UCB. GK received honorary from Abbvie, Amgen, Novartis, Pfizer, UCB. OK received honorary from Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB. ED received honorary from Abbvie, Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB. IE received honorary from Abbvie, Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB. SK received honorary from Abbvie, Amgen, MSD, Novartis, Pfizer, Roche, UCB. DE received honorary from Abbvie, Amgen, MSD, Novartis, Pfizer, UCB. CB received honorary from Abbvie, Amgen, MSD, Novartis, Pfizer, Roche, UCB. HE received honorary from Novartis, Roche. RM received honorary from Abbvie, Amgen, MSD, Novartis, Pfizer, Roche, UCB. NK received honorary from Novartis, UCB. SY received honorary from Abbvie, Amgen, Johnson and Johnson, MSD, Novartis, Pfizer, Roche, UCB. Other authors declare no conflict of interest.

Ethics approval

To perform the present research, the approval for the TReasure database was obtained from the Ethics Committee of Hacettepe University in May 2017 (KA17/058) and from the Republic of Turkey Ministry of Health in October 2017 (93189304-14.03.01).

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Written informed consent of all patients was obtained.

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Yagiz, B., Coskun, B.N., Pehlivan, Y. et al. In the era of disease-modifying antirheumatic drugs, how close are we to treating rheumatoid arthritis without the use of glucocorticoids?. Rheumatol Int 41, 1915–1924 (2021). https://doi.org/10.1007/s00296-021-04939-8

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