Study: Corticosteroid Use May Delay Initiation of Biologics in Patients With RA

Patients with rheumatoid arthritis (RA) who use corticosteroids can delay the initiation of biologic disease-modifying antirheumatic drugs (DMARDs), have higher incidence of adverse events (AEs), and have more healthcare costs before the initiation of biologic DMARDs than patients who do not use corticosteroids, according to a study published in Rheumatology and Therapy.

Patients with RA often use corticosteroids to quickly relieve pain or swelling. The American College of Rheumatology recommends low doses as a short-term therapy (up to 3 months) until patients can feel the benefits of DMARDs, due to adverse events related to long-term corticosteroid use, including weight gain, worsened diabetes, and increased risk of infection.

The researchers in this study used a retrospective analysis to measure patterns of corticosteroid use, the duration of use, and the dosage amount. Utilizing the Cox proportional hazards models, the effects of corticosteroid use on the amount of time it took to initiate DMARDs was also evaluated. In addition, the researchers analyzed the probability of AEs due to corticosteroid use.

25,542 patients with RA were included in the analysis. The mean patient age was 53.55 years, and over 70% of patients were female. Nearly 10% of these patients used corticosteroids for a long period of time (over 3 months). Most of these patients were older, more likely to be female, lived in the US South, were treated by a rheumatologist, and most importantly, had more comorbidities.

Corticosteroid users compared to non-users had significantly higher incidence rates of cardiovascular events, gastrointestinal events, infections, skin events, lipodystrophy, metabolic and endocrinologic events, neuropsychiatric events, and ophthalmologic events. They also had higher average health care costs compared to nonusers. Patients who used corticosteroids for longer durations at lower dosages were less likely to initiate biologic DMARDs.

The authors found that health care providers who prescribe corticosteroids for a longer period of time may not want to disrupt treatment by waiting for DMARDs to have an effect. It is recommended that physicians limit patient use of corticosteroids, as they delay early initiation of biologic DMARDs, which are associated with improved outcomes and decreased hospitalization.

“This study thus provides evidence that corticosteroid utilization may have deleterious effects on RA patient health and may increase the cost burden associated with treatment,” the authors concluded. “Future studies should continue to examine the appropriate and optimal use of corticosteroids and biologic DMARDs in RA treatment.”

Reference

Spivery CA, Griffith J, Kaplan C, Postlethwaite A, Ganguli A, Wang J. Published December 4, 2017. Rheumatol Ther. doi: 10.1007/s40744-017-0089-8.