RESEARCH - A two-year trial of IM depot steroids in patients with RA who have shown an incomplete response to DMARDs

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The ls of the Rheumatic Diseases

2005 March 10

A two-year randomised controlled trial of IM depot steroids in patients with

established rheumatoid arthritis who have shown an incomplete response to

disease modifying anti-rheumatic drugs

Choy EH, Kingsley GH, Khoshaba B, Pipitone N, DL.

King's College London, United Kingdom.

OBJECTIVES: In rheumatoid arthritis, intramuscular (IM) pulsed depomedrone

expedites the immediate response to disease modifying anti-rheumatic drugs

(DMARDs). Though IM depomedrone is also widely used to treat disease flares

in DMARD-treated patients, its effect on radiological progression has not

been assessed. We therefore undertook a 2-year prospective randomised

controlled trial to evaluate the benefits of 120mg IM depomedrone versus

placebo in established RA patients whose disease was inadequately controlled

by existing DMARDs. METHODS: Patients were assessed using the ILAR/WHO core

data set, disease activity score (DAS28), X-rays of hands and feet scored by

Larsen's method and bone densitometry. RESULTS: 291 RA patients were

screened, 166 were eligible and 91 consented and were randomised. Disease

activity improved more rapidly in the steroid-treated patients compared to

placebo but after 6 months no difference remained. There was also a small

but significant reduction in erosive damage in the steroid group compared to

placebo. There was a significant excess of adverse reactions in the

steroid-treated group (55 versus 42), especially those traditionally related

to steroids (15 versus 2) including vertebral fracture, diabetes and

myocardial infarction. Hip bone density fell significantly in

steroid-treated but not placebo patients.

CONCLUSIONS: IM depomedrone gave a short-term benefit in disease activity

and a small reduction in bone erosion at the cost of a significant increase

in adverse events. Despite the initial benefit of IM depomedrone, when

patients respond suboptimally to a DMARD, they should not be given long-term

additional steroids but should be treated with alternative or additional

DMARDs.

PMID: 15760929

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5760929 & dopt=Abstract

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