The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis

Nicole P. C. Konijn, Lilian H. D. van Tuyl, Maarten Boers, Peter M. van de Ven, Debby den Uyl, Marieke M. ter Wee, Pit Kerstens, AE Voskuyl, Dirkjan van Schaardenburg, Willem F. Lems, Michael T. Nurmohamed

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.

METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.

RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.

CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.

TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.

Original languageEnglish
Pages (from-to)1615-1622
Number of pages8
JournalRheumatology
Volume55
Issue number9
DOIs
Publication statusPublished - Sep 2016

Cite this

@article{c754e52086664eb184eb545902f4427b,
title = "The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis",
abstract = "OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.",
keywords = "Antirheumatic Agents/administration & dosage, Arthritis, Rheumatoid/complications, Body Composition/drug effects, Body Mass Index, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Obesity/complications, Overweight/complications, Prednisolone/administration & dosage",
author = "Konijn, {Nicole P. C.} and {van Tuyl}, {Lilian H. D.} and Maarten Boers and {van de Ven}, {Peter M.} and {den Uyl}, Debby and {ter Wee}, {Marieke M.} and Pit Kerstens and AE Voskuyl and {van Schaardenburg}, Dirkjan and Lems, {Willem F.} and Nurmohamed, {Michael T.}",
note = "{\circledC} The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.",
year = "2016",
month = "9",
doi = "10.1093/rheumatology/kew221",
language = "English",
volume = "55",
pages = "1615--1622",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",
number = "9",

}

The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis. / Konijn, Nicole P. C.; van Tuyl, Lilian H. D.; Boers, Maarten; van de Ven, Peter M.; den Uyl, Debby; ter Wee, Marieke M.; Kerstens, Pit; Voskuyl, AE; van Schaardenburg, Dirkjan; Lems, Willem F.; Nurmohamed, Michael T.

In: Rheumatology, Vol. 55, No. 9, 09.2016, p. 1615-1622.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The short-term effects of two high-dose, step-down prednisolone regimens on body composition in early rheumatoid arthritis

AU - Konijn, Nicole P. C.

AU - van Tuyl, Lilian H. D.

AU - Boers, Maarten

AU - van de Ven, Peter M.

AU - den Uyl, Debby

AU - ter Wee, Marieke M.

AU - Kerstens, Pit

AU - Voskuyl, AE

AU - van Schaardenburg, Dirkjan

AU - Lems, Willem F.

AU - Nurmohamed, Michael T.

N1 - © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PY - 2016/9

Y1 - 2016/9

N2 - OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.

AB - OBJECTIVE: To investigate the effect of two different high-dose, step-down prednisolone regimens on body composition in early RA patients after 26 weeks of treatment.METHODS: Prednisolone-naive patients with recent-onset RA (n = 108) were randomized to either COBRA (prednisolone 60 mg/day, tapered to 7.5 mg/day in 6 weeks; MTX and SSZ) or COBRA-light therapy (prednisolone 30 mg/day, tapered to 7.5 mg/day in 8 weeks and MTX). Body composition was assessed at baseline (before or soon after start of treatment) and after 26 weeks with DXA, and recorded as total body mass (TBM), total fat mass (FM), total lean mass (LM) and trunk/peripheral fat ratio. Log-ratio analyses assessed the proportional distribution of TBM (between LM, FM and bone mass) and FM (between trunk, extremities and head). The subgroup of patients with a DXA before start of treatment (n = 38) was analysed separately.RESULTS: In the subgroup of patients with a DXA before start of treatment, TBM increased by 1.6 kg (P < 0.001) and total FM by 1.3 kg (P < 0.001). The trunk/peripheral fat ratio and the proportional distribution of TBM and FM remained stable over time. There were no differences between the treatment groups. Similar results were obtained in the study population as a whole.CONCLUSION: Both high-dose, step-down prednisolone regimens caused increases in TBM, mainly caused by an increase in FM, but we found no fat redistribution from peripheral to central tissues. This absence in fat redistribution contradicts the widely held assumption of rapid adverse effects of prednisolone on body composition in RA.TRIAL REGISTRATION: ISRCTNregistry, http://www.isrctn.com, ISRCTN55552928.

KW - Antirheumatic Agents/administration & dosage

KW - Arthritis, Rheumatoid/complications

KW - Body Composition/drug effects

KW - Body Mass Index

KW - Dose-Response Relationship, Drug

KW - Drug Administration Schedule

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Obesity/complications

KW - Overweight/complications

KW - Prednisolone/administration & dosage

U2 - 10.1093/rheumatology/kew221

DO - 10.1093/rheumatology/kew221

M3 - Article

VL - 55

SP - 1615

EP - 1622

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 9

ER -