Can low dose prednisolone as an add-on treatment reduce the economic burden for patients with rheumatoid arthritis?

This study evaluated the cost-effectiveness of low-dose prednisolone (Omnipred) at 5 mg daily in the treatment of patients with rheumatoid arthritis (RA) aged 65 years or more. The study found that a low dose of prednisolone was an effective add-on treatment for patients with RA based on similar or lower costs compared to a placebo for over two years.

RA is a progressive, debilitating disease that causes inflammation of the joints, swelling, and pain. The disease results in economic burdens and reduced quality of life (QoL). RA is often managed by adding glucocorticoids (GCs) like prednisolone to anti-rheumatic medications.

GCs are effective at relieving RA symptoms and reducing the progression of disease activity and damage to joints. However, their long-term use is associated with side effects. Nonetheless, the use of GCs can potentially reduce the cost of treatment by delaying the use of biologics that are more expensive. Currently, the best approach for low-dose GCs as an additional treatment remains unclear. There is a need to investigate the cost-effectiveness and cost-utility of low-dose prednisolone in patients with RA that are over 65 years of age for a better understanding.

This study included 444 patients with RA, aged 65 years or more. Patients had a disease-activity score in 28 joints (DAS28) of at least 2.60. The patients were randomly assigned to treatment of either 5 mg of daily prednisolone as an add-on to standard care (221 patients) or a placebo with standard care (223 patients) for over 2 years. Evaluation measurements included DAS28 and EuroQoL-5 Dimension (EQ-5D) for determining the quality of life (QoL).

At baseline, patients had on average 4 underlying medical conditions (comorbidities). Prednisolone treatment resulted in slightly lower average total costs compared to the placebo. The total direct medical costs and DAS28 were lower with prednisolone compared to placebo. QoL scores were similar for both treatments.

The study concluded that the addition of a low dose of prednisolone to RA treatments over 2 years at similar or reduced costs lowered disease activity compared to placebo in patients aged 65 or higher.

The study had missing data. Also, information based on questionnaires is not always the most accurate.