Deflazacort in rheumatoid arthritis: A scoping review

Abstract

IntroductionCorticosteroids are hormones released by the adrenal gland that act on sodium and glucose metabolism and have anti-inflammatory properties. The first synthetic corticosteroids were prednisolone and prednisone. Deflazacort is the most recent of the synthetic corticosteroids, with molecular differences that bestow benefits such as, for example, in relation to sodium loss, anti-inflammatory potency and immunosuppressive activity, and lower interference on glucose and phosphocalcium metabolism. We decided to conduct this study to describe the effect of deflazacort compared to other corticosteroids in rheumatoid arthritis. Materials and methodsWe conducted a scoping review. A literature search was conducted in Pubmed, Cochrane and BVS databases, and in grey literature, for controlled clinical trials or equivalence studies conducted in adult patients with rheumatoid arthritis and the use of deflazacort versus other corticosteroids. We excluded articles that did not clearly mention the dose of deflazacort, or the comparator used. ResultsThe search of the 3 databases yielded 166 studies, of which 5 met the eligibility criteria and were included. Four studies evaluated deflazacort versus prednisolone, and one versus methylprednisolone. The results were similar for all 5: less decline in bone mineral density and glucose metabolism. ConclusionsDeflazacort and prednisolone have pharmacological differences that influence adverse effects at the level of bone and glucose metabolism. However, further studies are required for deflazacort to be used routinely in our practice, especially in diseases such as rheumatoid arthritis.