Takeaway
- Glucocorticoid (GC) use was associated with higher mortality rates in patients with rheumatoid arthritis (RA) and concomitant type 2 diabetes (T2D) vs patients with RA who did not have T2D, despite apparently reassuring similar relative risks.
Why this matters
- Rheumatologists should consider diabetes status while prescribing GCs to patients with RA given the potential impact of GC therapy on glucose control and mortality.
Study design
- This retrospective study included 9085 patients with RA (mean follow-up, 5.2 years) using data from the Clinical Practice Research Datalink (CPRD) which was linked to mortality data from the Office of National Statistics.
- Event rates for all-cause mortality and cardiovascular mortality were compared by GC use status and T2D status.
- Funding: Centre for Epidemiology Versus Arthritis and the NIHR Biomedical Research Centre.
Key results
- In patients with RA and T2D, the mortality rate was higher with GC exposure vs no exposure (67.4/1000 person-years [pyrs]; 95% CI, 57.1-79.5 vs 22.5/1000 pyrs; 95% CI, 18.7-27.1).
- Similarly, the mortality rate was higher in patients with RA who did not have T2D (GC exposure: 44.6/1000 pyrs; 95% CI, 40.6-48.9 and no GC exposure: 10.2/1000 pyrs; 95% CI, 9.1-11.4).
- The risk ratio (RR) of GC use on all-cause mortality was slightly lower in patients with RA and T2D vs those with RA alone (RR, 2.99; 95% CI, 2.32-3.87 vs 4.37; 95% CI, 3.77-5.07).
- Despite this lower RR, those with T2D had a higher rate difference vs those with no T2D (rate difference, 44.9 deaths/1000 pyrs; 95% CI, 32.9-56.8 vs 34.4 deaths/1000 pyrs; 95% CI, 30.1-38.7).
- A similar pattern was seen for cardiovascular mortality.
Limitations
- Retrospective design.
- Risk of misclassification.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
