Initial glucocorticoid bridging in rheumatoid arthritis: does it affect glucocorticoid use over time?

L van Ouwerkerk, P Verschueren, M Boers, P Emery, PHP de Jong, RBM Landewe, W Lems, JS Smolen, TW Huizinga, CF Allaart, SA Bergstra*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: To compare the use of glucocorticoids (GC) over time in patients with rheumatoid arthritis (RA) who were or were not treated initially with GC bridging therapy. Methods: Data from the BeSt, CareRA and COBRA trials were combined in an individual patient data (IPD) meta-analysis. We compared GC use between bridgers and non-bridgers at 12, 18 and 24 months from baseline with mixed-effects regression analysis. Secondary outcomes were mean cumulative GC dose until 24 months after baseline with and without the bridging period, Disease Activity Score based on 28 joints (DAS28) over time and number of disease-modifying antirheumatic drug (DMARD) changes. Results: 252/625 patients (40%) were randomised to GC bridging (bridgers). Excluding the period of bridging, later GC use was low in both groups and cumulative doses were similar. Mean DAS28 was similar between the groups, but bridgers improved more rapidly (p<0.001) in the first 6 months and the bridgers required significantly fewer changes in DMARDs (incidence rate ratio 0.59 (95% CI 0.38 to 0.94)). GC use was higher in the bridgers at t=12 months (OR 3.27 (95% CI 1.06 to 10.08)) and the bridging schedules resulted in a difference in cumulative GC dose of 2406 mg (95% CI 1403 to 3408) over 24 months. Conclusion: In randomised trials comparing GC bridging and no GC bridging, bridgers had a more rapid clinical improvement, fewer DMARD changes and similar late use of GC compared with non-bridgers. GC bridging per protocol resulted, as could be expected, in a higher cumulative GC dose over 2 years.

Original languageEnglish
Article numberard-2023-224270
Pages (from-to)65-71
Number of pages7
JournalAnnals of the rheumatic diseases
Issue number1
Early online date22 Aug 2023
Publication statusPublished - 22 Aug 2023

Bibliographical note

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© 2023 Annals of the Rheumatic Diseases. All rights reserved.


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