Brief High-Dose Prednisone Improves Active Ankylosing Spondylitis

A small, randomized clinical trial from Germany suggests that two weeks of high-dose oral prednisone produces a clinically relevant response in patients with active ankylyosing spondylitis (AS) refractory to NSAIDs.

One-third of the patients with active AS assigned to the high dose of oral prednisolone show a significantly greater response than those on placebo – a 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) versus just 8% -- after two weeks of treatment.

The high dose (50 mg/day) produced a clinically relevant improvement in discomfort, pain, and fatigue in fatigue, spinal pain, joint pain or swelling, tendon inflammation, and the severity and duration of morning stiffness, while the lower dose of 20 mg/day was not effective.

Interestingly, the authors saw a clear and significant decrease in inflammation as indicated by mean C-reactive protein (CRP) values in both prednisolone groups compared to placebo.

Although the numbers are small (just 39 patients) and fail to meet the primary endpoint  (a clinically relevant response in BASDAI scores for 40% of the high-dose group), the authors say that this is the first evidence of an effect for high-dose oral prednisone in NSAID-resistant AS, and warrants further study.

The trial did not assess whether improvements continue after treatment stops.
____________

REFERENCE

Haibel H, Fendler C, Listing J et al. Efficacy of oral prednisolone in active ankylosing spondylitis: results of a double-blind, randomised, placebo-controlled short-term trial. Ann Rheum Dis (2013) doi:10.1136 Published Online First, April 26.