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Year : 2016  |  Volume : 11  |  Issue : 4  |  Page : 216-221

Modified-release prednisone in rheumatoid arthritis: Rationale for chronotherapy, mechanistic considerations, and clinical implications

1 Centre for Rheumatology, Calicut, Kerala, India
2 Rheumatology and Translational Research Unit, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK

Correspondence Address:
Dr. Vinod Ravindran
Centre for Rheumatology, Calicut - 673 009, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-3698.192680

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Pain, stiffness of joints, and functional disability of rheumatoid arthritis (RA) are maximum in the morning. Cytokines, especially interleukin (IL)-6, demonstrate a circadian variation in patients with RA and contribute to the severity of aforementioned symptoms. Perturbed cortisol response in patients with RA is not effectively able to negate the effects of interleukin 6 rise in the early morning. Modified-release (MR) prednisone is a polymer-based drug delivery system which releases the drug 4 h after the ingestion of tablet closely simulating the cortisol rise and peak in patients with RA. In this review, we focus on the rationale for chronotherapy, mechanistic considerations, and clinical implications of MR prednisone.

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