LOW-DOSE CORTICOSTEROIDS IN RHEUMATOID-ARTHRITIS - A METAANALYSIS OF THEIR MODERATE-TERM EFFECTIVENESS

Objective. To perform a systematic literature review and meta-analysis of the effectiveness of low-dose corticosteroids in the treatment of rheumatoid arthritis (RA). Methods. After identifying all relevant stu dies meeting preselected inclusion criteria, we performed 2 meta-analy ses, First, we compared the effectiveness of prednisone to placebo and active drug controls (aspirin, chloroquine, or deflazacort) using sta ndard metaanalysis methods for continuous data, Then, to compare the r elative effectiveness of prednisone to second-line agents, we used met hods similar to prior meta-analyses of second-line agents for RA treat ment, Outcomes assessed were the number of tender and swollen joints, grip strength, and the erythrocyte sedimentation rate (ESR). Results. Very few studies directly assessed the effectiveness of corticosteroid s for RA treatment, and many were of poor methodologic quality, Only 9 of 34 studies identified by our search met criteria for inclusion, Th e results of our standard meta-analysis indicated that corticosteroids appeared to be more effective than either placebo or active drug cont rols in improving most conventional outcome measures (effect size 0.90 for the number of tender joints, 1.05 for the number of swollen joint s, and 1.20 for the ESR). In our second comparative meta-analysis, cor ticosteroids were nearly equivalent to second-line agents previously e xamined in meta-analyses (combined effect size 0.82). Conclusion. Base d on the limited data available, during moderate-term treatment period s averaging slightly over 7 months, corticosteroids appeared to be as effective or more effective than alternative therapies in improving se veral common RA disease activity measures.