Added RA relief with nighttime-release prednisone?

In an investigation of the effects of long-term low-dose chronotherapy with modified-release (MR) prednisone for rheumatoid arthritis (RA) on the hypothalamic-pituitary-adrenal (HPA) axis, treatment with nighttime-release prednisone did not change adrenocortical function over 12 months. Chronotherapy with this prednisone may improve the effectiveness of long-term low-dose corticosteroid treatment in patients with RA.

As part of the Circadian Administration of Prednisone in Rheumatoid Arthritis trial (CAPRA-1), Alten and colleagues explored the effects of chronotherapy with an MR nocturnally administered prednisone formulation that suppresses the morning cortisol surge. They performed corticotropin-releasing hormone (CRH) tests on 288 patients at baseline, during treatment with immediate-release (IR) prednisone; after 3 months on IR or MR prednisone; and after a 9-month open-label extension on MR prednisone.

Treatment with MR prednisone for 12 months did not change the CRH test results. Cortisol levels were unchanged from baseline (IR prednisone) to end of study (MR prednisone). Thus, there was no new HPA axis suppression. Patients taking MR prednisone for up to 12 months remained free of adverse effects.

The authors proposed that treatment with MR prednisone can offer an extra dose of medication when it is most needed, thereby potentially providing additional control of RA.