J Rheum Dis.  2015 Apr;22(2):76-84. 10.4078/jrd.2015.22.2.76.

Clinical Experience with Low-dose Modified-release Prednisone Chronotherapy in Asian Patients with Rheumatoid Arthritis in Singapore

• Yoon KH

• KMID: 2222909
• DOI: http://doi.org/10.4078/jrd.2015.22.2.76

Abstract

OBJECTIVE
To examine the demographic profile and treatment patterns in patients with rheumatoid arthritis (RA) prescribed low-dose modified-release prednisone (LODOTRA(R)) on a named patient basis in Singapore and to evaluate safety and clinical outcome of the treatment.
METHODS
Medical records of adult patients with RA who had inadequate responses to prior RA treatment and were prescribed low-dose modified-release prednisone between January and December 2012 at a specialist clinic were reviewed retrospectively. Demographics, treatment information, relevant laboratory evaluations, and disease condition, prior to and after the start of treatment, were collected.
RESULTS
Thirty-eight patients were enrolled. The mean age was 52.8 years and median disease duration was 1.3 years (0.04 to 8.2 years). Patients received a mean daily dose of 5.0+/-1.0 mg of modified-release prednisone for a median period of 4.4 months (0.2 to 11.8 months). Before treatment, the majority of patients received disease-modifying anti-rheumatic drugs (78.9%), glucocorticoids (71.0%), and non-steroidal anti-inflammatory drugs (NSAIDs) (68.4%). After the start of treatment, prescription of NSAIDs declined from 68.4% to 28.9%. Similar laboratory findings were observed before and after treatment. The median C-reactive protein level decreased substantially from 9.8 mg/L (0.2 to 77.7 mg/L) to 3.9 mg/L (0.4 to 27.6 mg/L). High proportions of patients reported improvement or recovery from morning stiffness (94.7%) or joint pain (70.0 to 100.0%) after treatment. The median number of painful joints decreased from 4 (1 to 8) to 0 (0 to 4) after treatment.
CONCLUSION
Our clinical experience in Asian patients with RA suggests that low-dose modified-release prednisone chronotherapy is associated with similar treatment patterns, safety profile, and clinical outcomes as in Western populations.

Keyword

Rheumatoid arthritis; Prednisone; Chronotherapy; Asians; Singapore

MeSH Terms

Adult
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Arthralgia
Arthritis, Rheumatoid*
Asian Continental Ancestry Group*
C-Reactive Protein
Chronotherapy*
Demography
Glucocorticoids
Humans
Joints
Medical Records
Prednisone*
Prescriptions
Retrospective Studies
Singapore*
Specialization
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
C-Reactive Protein
Glucocorticoids
Prednisone

Figure

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  Figure 1. Prescription of maintenance medication among patients with rheumatoid arthritis before and after the start of low-dose modified-release prednisone chronotherapy. DMARDs: disease modifying anti-rheumatic drugs, NSAIDs: nonsteroidal anti-inflammatory drugs.

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  Figure 2. Course of disease condition after the start of low-dose modified-release prednisone chronotherapy compared to baseline. *Among patients with morning stiffness or pain at baseline.

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