Could initiating bridging therapy for early rheumatoid arthritis be worth it?

While there are concerns over the safety of glucocorticoids (GC) bridging therapy with for early rheumatoid arthritis (RA), a new study suggests bridging may be worth it. As background, a study in the Annals of Rheumatoid Arthritis by researchers in Europe stated, “GC have significant safety issues if used long term, especially when used in higher doses. Therefore, the 2022 updated EULAR recommendations state that only short-term GC bridging therapy should be considered,” The American College of Rheumatology 2021 updated guidelines also have concerns about toxicity issues related to bridging and advise not to even start GC bridging therapy. But after analyzing data from three large randomized trials comparing bridging to non-bridging, researchers concluded that bridgers had a more rapid clinical improvement, fewer DMARD changes and similar late use of GC compared with non-bridgers. In a previous research, “we showed that in clinical trial patients treated with GC bridging therapy the rates of subsequent ongoing GC use are low and decreasing over time. Thus, we did not find evidence that GC bridging is associated with unwanted prolonged use.” The current study analyzed data from three studies: BeSt, COBRA and CareRA. They had each randomized patients to at least one study arm with GC bridging next to one or multiple conventional synthetic disease-modifying antirheumatic drug (csDMARD), and an arm with no GC bridging. “We tested whether initial GC bridging would affect whether patients would be more likely to (re)start GC over time,” the authors wrote. Combined, there were 625 patients, 252 (40.3%) of whom were started with GC bridging. A majority (67%) were female and had a mean age of 52 years. Initial GC use was high in in those who had GC bridging. There were data for two-year follow-up. It was found that the proportion of patients using GCs and the cumulative GC dose after a year were similar between bridgers and non-bridgers. Bridgers showed low disease activity significantly earlier than non-bridgers. At the completion of bridging, bridgers and non-bridgers had similar diseases activity score over time, but non-bridgers had more DMARD changes. GC bridging resulted in a 2,400 mg higher cumulative GC dose in the bridgers compared with the non-bridgers over the total follow-up of two years but that included the bridging period, the study said.

Could initiating bridging therapy for early rheumatoid arthritis be worth it?

Register for free access or login.

Related Topics