Very-low-dose glucocorticoid therapy in rheumatoid arthritis: impact of b/tsDMARDs initiation timing on glucocorticoid withdrawal
Authors' conclusion
A substantial proportion of RA patients treated with b/tsDMARDs continue to receive very-low-dose GCs without significantly improving disease control. However, this appears to increase cardiovascular morbidity.
Study context
- Population
- RA patients starting first b/tsDMARDs at one institution, 2015–2020, monitored every 6 months for 3 years
- Participants
- 229 patients
- Exposure
- Very-low-dose glucocorticoids (GCs) vs no GCs in RA patients starting b/tsDMARDs
- Outcome
- Very-low-dose GC use and its relationship with disease activity and safety
- Follow-up
- 3 years
Methodological detailssingle-centre, multivariable logistic regression, repeated-measures ANOVA
- Single-centre
- Multivariable logistic regression
- Repeated-measures ANOVA
Main finding
As reported in the abstract
Very-low-dose GC use pattern
- Prescribed very-low-dose GCs at enrolment
- 68%
- No GCs at enrolment
- 32%
- Never abandoned very-low-dose GCs
- 32%
- Gone on and off very-low-dose GCs
- 20%
- Permanently discontinued very-low-dose GCs
- 23%
- Never taken GCs
- 25%
Observational data: associations, not effects.
Further findings
Predictor of very-low-dose GC cessation: shorter disease duration at b/tsDMARD initiation (per 1-year decrease)
- OR
- 1.1 (95% CI 1.03, 1.14); P = 0.001
- Single modifiable predictor
Disease activity
- Significant association between ongoing very-low-dose GC use and persistent moderate disease activity
Safety
Hypertension
MI
Original publication
Very-low-dose glucocorticoid therapy in rheumatoid arthritis: impact of b/tsDMARDs initiation timing on glucocorticoid withdrawal. Rheumatology (Oxford). Published 4 February 2024. doi:10.
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