Rheumatoid arthritis: incidence and risk of glucocorticoid-related adverse events

  • Wilson JC & al.
  • Arthritis Care Res (Hoboken)
  • 1 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Patients with rheumatoid arthritis (RA) were at a substantially increased incidence of glucocorticoid (GC)-related adverse events (AEs).
  • Increasing cumulative and average daily GC doses were associated with a greater risk of developing an AE.

Why this matters

  • Findings highlight the clinical burden associated with current and long-term, high-dose oral GC use in patients with RA and emphasize the importance of clinical awareness of GC-related AEs.

Study design

  • This study included 34,050 patients with RA and 1:1 matched patients without RA using data from the UK Clinical Practice Research Datalink (CPRD).
  • Funding: F. Hoffmann-La Roche and Genentech, Inc.

Key results

  • RA patients with a GC prescription vs. non-RA patients with a GC prescription had a higher incidence of severe AEs:
    • diabetes (incidence rate ratio [IRR], 1.33; 95% CI, 1.12-1.56);
    • osteoporosis (IRR, 2.30; 95% CI, 2.00-2.65);
    • fractures (IRR, 1.34; 95% CI, 1.17-1.54);
    • hypertension (IRR, 1.40; 95% CI, 1.26-1.57);
    • thrombotic stroke or myocardial infarction (MI; IRRs, 1.45; 95% CI, 1.19-1.76);
    • gastrointestinal perforation or bleeding (IRR, 1.59; 95% CI, 1.21-2.08);
    • mortality (IRR, 1.26; 95% CI, 1.16-1.37); and
    • serious infection (IRR, 1.24; 95% CI, 1.06-1.44).
  • In patients with RA, GC use was associated with an increased risk of:
    • diabetes (adjusted OR [aOR], 1.33; 95% CI, 1.14-1.56);
    • osteoporosis (aOR, 1.41; 95% CI, 1.25-1.59);
    • thrombotic stroke or MI (aOR, 1.28; 95% CI, 1.07-1.52);
    • serious infection (aOR, 1.28; 95% CI, 1.11-1.48); and
    • mortality (aOR, 1.33; 95% CI, 1.19-1.48).
  • Both increasing cumulative and average daily GC doses (Ptrend<.05 for both were associated with increased risks of diabetes osteoporosis fractures infections thrombotic stroke or mi and mortality.>

Limitations

  • Possibility of competing risks.