287 z A DOUBLE-BLIND STUDY OF DEFLAZACORT AND PREDNISONE IN PATIENTS WITH CHRONIC INFLAMMATORY DISORDERS RICHARD E. S. GRAY, SHEELAGH M. DOHERTY, JOHN GALLOWAY, LES COULTON, MARC DE BROE. and JOHN A. KANIS Deflazacort and prednisone were given to 26 patients with rheumatoid arthritis, polymyalgia rheu- matica, or other chronic inflammatory diseases, in a double-blind study. Deflazacort rapidly and effectively suppressed disease activity in a manner supporting its assumed therapeutic potency of 83% that of prednisone. Prednisone induced a rapid increase in the level of daily calcium excretion that was not evident with deflazacort. Cortisol secretion was acutely inhibited by prednisone, but not by deflazacort. Neither corticosteroid had a significant effect on glucose metabolism, at the doses studied. Treatment with deflazacort may be an effective alternative to prednisone treatment, with fewer adverse effects on levels of calcium and cortisol, in patients with From the Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School, Sheffield, United Kingdom; the Department of Rheumatology, Hull Royal Infirmary. Hull, United Kingdom: and the Department of Nephrol- ogy. University of Antwerp. Edegem, Belgium. Supported in part by the Medical Research Council. Dr. Gray’s work was supported by the Arthritis and Rheumatism Council. Richard E. S. Gray, MRCP: Department of Human Metab- olism and Clinical Biochemistry. University of Sheffield Medical School: Sheelagh M. Doherty, FRCP: Department of Rheumatol- ogy, Hull Royal Infirmary: John Galloway, PhD: Department of Human Metabolism and Clinical Biochemistry, University of Shef- field Medical School; Les Coulton, PhD: Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Med- ical School: Marc de Broe. MD: Department of Nephrology, Uni- versity of Antwerp: John A. Kanis, MD: Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Med- ical School. Address reprint requests to Richard E. S. Gray, MRCP, Department of Rheumatology, Royal Surrey County Hospital, Eger- ton Road, Guildford, Surrey GU1 5XX, UK. Submitted for publication May 19, 1989; accepted in revised form October 8, 1990. severe inflammatory conditions warranting the use of glucocorticoids. The adverse effects on bone mass (1-6), glucose metabolism (7,8), and endogenous secretion of cortisol (8-10) associated with long-term glucocorticoid treat- ment are well established. The use of these drugs is generally restricted to patients who have very severe inflammatory conditions. A number of clinical studies have suggested that deflazacort zyx , an oxazoline analog of prednisone, may have fewer adverse effects than prednisone or prednisolone, at doses with equivalent antiinflammatory activity. Deflazacort has been found to have less marked short-term effects on intestinal calcium absorption (1 1-13), urinary excretion of cal- cium (11,1416) and hydroxyproline (11,15,16), and serum cortisol (8,16,17) and blood glucose levels (8,1618). In addition, treatment with deflazacort for several months or longer induces less bone loss than is seen after the use of other corticosteroids, as assessed by photon absorptiometry (19-21) or by bone histo- morphometry (12,22). The majority of studies have examined the effects of relatively short-term treatment with deflaza- cort, in patients (8,11,13-15,17,18,23) or normal sub- jects (14,17,24). It has thus been difficult to compare the relative therapeutic efficacy of deflazacort and prednisone in relation to their adverse effects. Indeed, only two studies have examined specifically the ther- apeutic efficacy of deflazacort (23,25). Both compared deflazacort with prednisone, but only one (23) used a double-blind study design, and that for only 7 days. Therefore, we initiated a double-blind study of de- flazacort and prednisone in patients who were begin- Arthritis and Rheumatism, Vol. 34, No. 3 (March 1991)