The clinical and cost effectiveness of oraL vErsus intrAmuscular glucocorticoiDs in rhEumatoid aRthritis (LEADER)

A clinical trial is directly comparing daily steroid tablets against intramuscular injections to find which works better—and causes fewer side effects—for people with active rheumatoid arthritis who are starting or changing their usual medication. This matters because glucocorticoids are widely used as a short-term “bridge” to control inflammation while slower-acting disease-modifying drugs take effect, but doctors lack clear evidence on whether tablets or injections are more effective, safer, and more acceptable to patients. Both routes have different risks: tablets are convenient but require daily adherence and may cause cumulative toxicity; injections deliver a single dose but require a clinic visit and can cause injection-site reactions. If the trial shows one route is clearly superior, it could change standard NHS practice for thousands of patients each year. A clear winner would allow clinicians to prescribe the most effective and least toxic option from the start, reducing unnecessary side effects and improving disease control during a critical treatment transition. The embedded economic evaluation will also tell the NHS whether the better option is cost-effective, helping to guide routine prescribing decisions.