Continuing versus tapering glucocorticoids after achievement of low disease activity or remission in rheumatoid arthritis (SEMIRA): a double-blind, multicentre, randomised controlled trial

In patients with stable, low activity RA receiving tocilizumab+/- DMARDs plus low-dose glucocorticoids (n=259), continuation of prednisone 5mg daily was associated with better disease control than a taper (difference of 0.61 in mean change in DAS28-ESR at wk 24; p<0.0001).

SPS commentary:

Despite the main result favouring continuation of low-dose prednisolone, treatment was regarded as successful (low disease activity at week 24, plus absence of flare for 24 weeks and no confirmed adrenal insufficiency) in 65% of those who had their dose tapered (775 in those who continued treatment).

A related commentary states these findings provide compelling evidence that continuation of low dose prednisolone in these patients is a relatively safe option that leads to improved outcomes over cessation of prednisolone. However the study’s short duration precludes an evaluation of the long-term adverse effects of continuing prednisolone therapy.  In addition although the authors report no symptoms of adrenal insufficiency following the taper, it is possible that this may have been mistaken for worsening disease activity in some patients. The authors suggest a more flexible taper regimen based on previous exposure to glucocorticoids may yield better outcomes.


The Lancet

Resource links: