A RECENT trial comparing two approaches to glucocorticoid withdrawal in patients with rheumatoid arthritis (RA) found no significant difference in success rates between hydrocortisone replacement and prednisone tapering strategies. The Strategies for glucocorticoid TApering in Rheumatoid arthritis (STAR) trial aimed to identify the most effective method for helping patients with low disease activity (LDA) safely discontinue glucocorticoid therapy, which is commonly prescribed but linked to long-term side effects.
In this double-blind, placebo-controlled trial, 102 RA patients with stable low-dose glucocorticoid use were randomly assigned to one of two tapering methods. One group gradually replaced prednisone with hydrocortisone, starting with a dose of 20 mg per day and reducing it over six months before stopping completely. The other group slowly tapered prednisone, reducing the dose by 1 mg per month until discontinuation, as long as their RA symptoms remained controlled.
After a year, 55% of patients in the hydrocortisone group and 47% in the prednisone tapering group successfully stopped glucocorticoid use, with no statistically significant difference between the groups. Secondary outcomes, including RA flare-ups, additional glucocorticoid requirements, disease activity, and patient-reported quality of life, also showed no meaningful differences.
The study’s safety profile was encouraging, as no cases of acute adrenal insufficiency occurred. However, 17 patients across both groups displayed abnormal results in the ACTH stimulation test, indicating that some may still experience adrenal impairment after stopping glucocorticoids.
These findings suggest that either strategy can be considered when tapering glucocorticoids in RA patients with LDA, providing flexibility for clinicians based on individual patient needs. The study underscores the importance of further research to refine tapering methods and better support adrenal health in patients discontinuing long-term glucocorticoid therapy.
Reference
Ruyssen-Witrand A et al. Comparison of two strategies of glucocorticoid withdrawal in patients with rheumatoid arthritis in low disease activity (STAR): a randomised, placebo-controlled, double-blind trial. Ann Rheum Dis. 2024. DOI:10.1136/ard-2024-226620.
