Short-term prednisolone bridging enables 95% discontinuation in new rheumatoid arthritis patients after 24 monthsMost patients stop steroid use after a short bridge to methotrexate treatment

OBJECTIVES: The objective of this paper is to examine whether patients with newly diagnosed rheumatoid arthritis (RA) can discontinue prednisolone after short-term bridging therapy. METHODS: Patients naïve to disease-modifying antirheumatic drugs with recent-onset RA in the ARCTIC (Aiming for Remission in rheumatoid arthritis: a randomised trial examining the benefit of ultrasound in a Clinical TIght Control regimen) trial were followed for 24 months, with initial methotrexate monotherapy and prednisolone bridging therapy (tapering doses from 15 mg to 0 over 7 weeks). We explored the proportion of patients successfully discontinuing prednisolone, defined as no prednisolone use after bridging therapy, and for at least 4 subsequent months. Discontinuation was assessed after cessation of bridging therapy at 2, 3, 6, 12, 20, and 24 months. Additionally, we examined how many patients used prednisolone continuously for ≥3 months. RESULTS: Of 230 patients, 227 started prednisolone bridging therapy and were included for analyses. At baseline, mean (SD) age was 52 (13.7) years, mean (SD) disease activity score was 3.47 (1.17), 62% patients were female, and 82% patients were anticitrullinated peptide antibody positive. After 7 weeks, 84% (191/227) had discontinued prednisolone, 89% (203/227) had discontinued at 3 months, and 95% (216/227) within 24 months. Five percent (11/227) used prednisolone at every visit. The median number of days (IQR) of prednisolone use during 2 years was 55 (48-90). Among those who discontinued after 7 weeks, 80% (152/191) did not restart prednisolone. Continuous use for at least 3 months was observed in 22%. CONCLUSIONS: In newly diagnosed patients with RA using bridging therapy when starting methotrexate, over 80% successfully discontinued prednisolone. This supports that tapering to discontinuation is achievable in most patients after short-term bridging with prednisolone, in line with current European Alliance of Associations for Rheumatology recommendations.