Modified release prednisone in patients with rheumatoid arthritis.

Since the demonstration of the potent anti-infl ammatory and immunosuppressive effects of glucocorticoids (GCs) halfway through the previous century, GCs have been the most frequently and generally used anti-infl ammatory and immunosuppressive class of drugs in a wide spectrum of immune-mediated diseases such as systemic autoimmune diseases, including the arthritides like rheumatoid arthritis (RA), vasculitides and allergic conditions. Their low cost has enabled their application worldwide. The rationale for their use in active RA is the fast symptomatic relief through inhibition of the infl ammatory process.1 In addition, in the last decades GCs have also been shown to inhibit radiographic joint damage in early RA, which led to the paradigm shift that GCs are disease-modifying antirheumatic drugs (DMARDs).2 3 In modern treatment strategies which aim for fast remission in patients with early RA (tight control strategies), GCs are often used in combination with other DMARDs.4 5 Although the adverse effect (AE) spectrum of lowto medium-dose GCs seems to be modest,6 AEs of GCs have been an issue for many years. Research has been aimed at decreasing the risk of AEs of GCs and at improving the therapeutic ratio of this class of drugs. In this paper, after a short description of developments to improve the therapeutic ratio of GCs, we will discuss modifi ed-release prednisone (MR prednisone) and the study published in this issue on this new drug formulation.7