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

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.

• 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.

• 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 (P_trend<.05 for both) were associated with increased risks of diabetes, osteoporosis, fractures, infections, thrombotic stroke or MI, and mortality.

• Possibility of competing risks.