As per the subanalysis of the CareRA randomized controlled trial, initial oral glucocorticoid  bridging reduced chronic non-steroidal anti-inflammatory drug (NSAID) and analgesic intake in patients with RA considered to have favourable prognosis.

The study researchers investigated NSAIDs and analgesics intake in early RA (less than or equal to 1 year) with a favourable risk profile (no erosions, negative for the presence of rheumatoid factor and anti-citrullinated protein antibodies or low disease activity) commencing methotrexate (MTX) with or without GC bridging.

Participants were randomized to MTX 15 mg with a step-down GC plan (COBRA Slim) (n=43), or MTX without oral GCs i.e. Tight-Step-Up plan (TSU) (n=47). The frequency, start/end date and indication associated with analgesics were noted down. Intake of NSAIDs for ≥90 days, acetaminophen, opioids plus tramadol and antidepressants indicated for musculoskeletal pain were taken into consideration.

Prior to the study, more patients in the COBRA Slim used analgesics. During the trial, patients used 67 and 107 NSAID and analgesics in COBRA Slim and TSU group (details in table 1):

Overall, the number of patients on NSAID and analgesics at any time during the study and  chronically considerably varied between the groups. Also, the number of patients on daily chronically NSAIDs was markedly different.