The following is a summary of “Concomitant prednisone may alleviate methotrexate side-effects in rheumatoid arthritis patients,” published in the May 2023 issue of Rheumatology by Leeuw et al.
Researchers conducted a retrospective study to assess low-moderate dose prednisone’s potential to reduce methotrexate (MTX) side-effects in rheumatoid arthritis (RA) patients. A post-hoc analysis of CAMERA-II: 236 early DMARD and prednisone naive RA patients randomized (1:1) to MTX + prednisone 10 mg daily or MTX monotherapy for two years. MTX dose escalated with treat-to-target. The Generalized Estimating Equations model analyzed MTX side-effects and adverse events, controlling for disease activity and amount. Prednisone effect assessed in the U-ACT-EARLY trial with tocilizumab (TCZ) and MTX vs. MTX monotherapy.
The results showed the analysis of the Prednisone-MTX group with 5.9% MTX side effects vs. 11.2% in MTX monotherapy. After controlling for variables, prednisone reduced MTX side effects significantly (OR: 0.54, CI: 0.38–0.77, P= 0.001). Nausea (OR 0.46, CI: 0.26–0.83, P= 0.009) and elevated ALT/AST (OR 0.29, CI: 0.17–0.49, P< 0.001) decreased. The trend of fewer overall adverse events with prednisone-MTX (OR: 0.89, CI: 0.72–1.11, P= 0.30). No difference in MTX side effects between TCZ-MTX and MTX monotherapy in U-ACT-EARLY (OR 1.05, CI: 0.61–1.80, P= 0.87).
They concluded that prednisone daily, in addition to MTX treatment, may reduce nausea and ALT/AST.