NEW YORK (Reuters Health) - When it comes to initial drug treatment for rheumatoid arthritis, many sufferers would prefer not to have to take the steroid prednisone, a survey shows.
"Dislike for prednisone seems to be strong and widespread," lead investigator Dr. Yvonne P. M. Goekoop-Ruiterman told Reuters Health, adding, "patients have a strong preference to receive treatment with the newest drug with promising results."
Rheumatoid arthritis, or RA, is a disease in which the body's own immune system attacks the joint lining. The potentially crippling illness can cause pain and joint stiffness on both sides of the body. Treatment typically involves the use of drugs that reduce pain and swelling, such as prednisone.
Dr. Goekoop-Ruiterman of Leiden University Medical Center and colleagues evaluated survey responses from 440 adults who had taken part in a clinical trial of treatments for RA that included methotrexate and prednisone -- two older RA drugs -- and infliximab (Remicade) -- a newer anti-RA drug. The patients had had therapy for an average of 2.2 years.
Despite similar outcomes in terms of disease activity in all treatment groups, only 46 percent of those in the initial prednisone group reported considerable improvement in general health. In the infliximab group, on the other hand, 74 percent reported much or very much improvement.
Almost half of the respondents expressed no preference or aversion to a particular treatment group. One third wanted to be in the infliximab group, and about 38 percent had hoped not to start with prednisone.
Half of the patients in the prednisone group disliked taking the drug. In contrast, only 8 percent of the infliximab group disliked having to go to the hospital for injections of the drug.
"The dislike of prednisone," say the investigators, "revolves around (mis)information about possible side effects, whereas for the newer TNF-blocking agents information appears to focus on the efficacy and less on possible (future) side effects."
Thus, there is a need for better patient education about the efficacy and toxicity of both steroids and TNF-blockers, they conclude.
SOURCE: Annals of the Rheumatic Diseases, September 2007.
