2018 eular recommendations for the use of glucocorticoid therapy

F. ButtgereitDepartment of Rheumatology and Clinical Immunology, CharitÉ University Medicine Berlin, 10117 Berlin, Germany  Glucocorticoids (GC) are potent anti-inflammatory and immunosuppressive drugs which are used successfully to treat many disorders, including rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, myositis, systemic lupus erythematodes and other rheumatic diseases. However, these drugs also have the potential to cause severe adverse effects, particularly if high doses are used for prolonged periods. Therefore, the benefits of GC therapy must be balanced against the potential risks. Key strategies to achieve this goal include (i) following guideline recommendations regarding GC therapy dosing, monitoring for potential adverse events, and adverse event prevention and management, (ii) using or developing new therapeutic advances to improve the therapeutic balance. The EULAR Glucocorticoid Task Force has already published several recommendations over the last years such as those on the standardised nomenclature for GC dosages and treatment regimens, on the management of systemic GC therapy in rheumatic diseases, and on monitoring adverse events of low-dose GC therapy. Recent work of this group dealt with the question under which conditions long-term treatment with GC has an acceptably low level of harm. As a result, the task force members agreed that the risk of harm is low for the majority of patients at long-term dosages of ≤5 mg prednisone equivalent per day, whereas at dosages of >10 mg/day the risk of harm is elevated. At dosages between >5 and ≤10 mg/day, patient-specific characteristics determine the risk of harm. This means general and glucocorticoid-associated risk factors and protective factors such as a healthy lifestyle should be taken into account when evaluating the actual and future risk. Another new information on the use of GCs has been recently provided by EULAR 2016 update of RA recommendations: “Short-term GCs should be considered when initiating or changing csDMARDs, in different dose regimens and routes of administration, but should be tapered as rapidly as clinically feasible.” This wording does acknowledge that there are several different regimens for oral use, intramuscular injection, and intravenous pulse therapy. It is now also being stated more clearly that GCs should be given as bridging therapy together with csDMARDs, either as part of the initial strategy or subsequently if this has failed. In contrast, GCs are usually not needed as a bridging therapy when bDMARDs or tsDMARDs are used. This recommendations reconfirms that GCs should be gradually reduced and ultimately stopped, ideally within 3 to 6 months. Finally, the role of GCs in the management of polymyalgia rheumatica as has been described and discussed by the recent EULAR/ACR recommendations will be briefly discussed. Disclosure of Interest: F. Buttgereit Grant/research support from: Mundipharma, Horizon, Pfizer, Consultant for: Horizon, Pfizer, Speakers bureau: Horizon, Pfizer, DOI: 10.1136/annrheumdis-2018-eular.7690 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A42Session: Recommendation session ESSCA