Table 3.
Details of the studies investigating the potential predictors of long-term treatment with glucocorticoids (GCs)
| Author, year | Patients (N) | Type of Study | Recruitment period | Classification criteria | Potential predictors of long-term GC treatment |
|---|---|---|---|---|---|
| Hattori K, 2020 [35] | 50 | R | 2010–2017 |
Bird’s ACR/EULAR |
Normalization of CRP at 1 month associated with higher likelihood of achievement of GC-free remission (OR = 5.83). No association was recorded with age and sex |
| Aoki A, 2020 [15] | 93 | R | 2011–2020 |
Bird’s ACR/EULAR |
Relapse till 6 months associated with long-term GC therapy (OR 6.40). No association was demonstrated with age, sex, APR, GC starting dose |
| Marsman DE, 2020 [17] | 454 | R | 2008–2018 | Physician’s diagn | Normal APR had shorter median time to GC-free remission (552 vs. 693 days). However, when the GC-retention rate at 1 and 2 years were evaluated, no significant differences were identified. Analysis focused on APR; thus, other candidate predictors were not assessed |
| Giollo A, 2019 [20] | 385 | R | < 2017 | ACR/EULAR | Older age (adjHR, 1.02), peripheral involvement (adjHR 1.38), higher CRP (adjHR 1.29), higher initial dosage of GC (adjHR 0.96), higher hemoglobin (adjHR 0.86), osteoporosis (adjHR0.75), and the use of amino bisphosphonates (adjHR0.65) associated with persistence in GC therapy. A trend to significant association was recorded with relapses. No association with sex and MTX or other DMARDs was recorded |
| Albrecht K, 2018 [21] | 172 | P | 2007–2014 | Physician's diagn | Baseline MTX (OR 2.03) GCs > 10 mg/day (OR 1.65), higher disease activity (OR 1.12) (median 0.6 years DD), and female sex (OR 1.63 [1.09–2.43]) were predictive for GC therapy at ≥ 3 years. No association was found with age and APR |
| Shbeeb I, 2018 [22] | 359 | R | 200–2014 | ACR/EULAR | Initial dose of GC was not associated with time to permanent discontinuation (HR 1.06 per 5 mg/day increase, 95% CI 0.96–1.18). Other possible predictors were not assessed |
| Miceli MC, 2017 [23] | 66 | P | na | ACR/EULAR | N of GC-free patients at 12 months was comparable among patients with or without musculoskeletal ultrasonography (MSUS) inflammatory findings at the baseline [14 (30.4%) in MSUS-positive vs 6 (30.0%) in MSUS-negative |
| Mackie SL, 2010 [25] | 22 | R | 1989–2000 | Bird’s | A higher plasma viscosity increases the risk of prolonged steroid therapy and late GCA. Starting patients on > 15 mg prednisolone is associated with a prolonged steroid duration. Age and sex did not associate with risk of prolonged GC duration |
| Cimmino MA, 2008 [26] | 57 | Obs. Ext. of RCT | 1998–1999 | Chuang’s | No GC-sparing effect of MTX was demonstrated. Other DMARDs were not assessed. Age, sex and APR did not associate with GC treatment duration |
| Myklebust G, 2001 [28] | 217 | P | 1987–1994 | Bird’s | Higher mean maintenance GC dose in 1st yr (6.1 vs. 4.8 mg/day of PDN), higher mean pretreatment ESR (73 vs. 60 mm/h) lower hemoglobin (12.3 vs. 12.9 g/dL). No significant association with initial GC dosage and APR |
| Weyand CM, 1999 [29] | 27 | P | 1993–1996, > 1 yr | Physician’s diagn | ESR and non-responsiveness of interleukin 6 to steroid therapy are helpful in dividing patients into subsets with different treatment requirements |
P, prospective; R, retrospective; Obs.ext. of RCT, observational extension of a randomized clinical trial; Mths, months, yrs; Yrs, years; Rheum, rheumatology; APR, acute-phase reactants; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; OR, odds ratio; HR, hazard ratio; adjHR, adjusted HR; NA, not available; MTX, methotrexate; ACR, American College of Rheumatology; EULAR, European League Against Rheumatisms