Use of Glucocorticoids in Treating RA Is on the Decline

Glucocorticoid are used in approximately 60% of all patients who have rheumatoid arthritis (RA), and while these drugs have significant benefits for patients, they are not without the risk of adverse events. A newly published study in Arthritis Research and Therapy found that, among Australian patients with RA who participated in a national registry, oral glucocorticoid use has decreased over time, with both reduced initiation and increased cessation of treatment with these drugs.

The study, which sought to describe the use of glucocorticoids among patients enrolled in the Australian Rheumatology Association Database (ARAD) and to determine factors associated with glucocorticoid use, commencement, and cessation, included censored data from adult patients diagnosed with RA. Patients (n = 3699) completed a baseline questionnaire and follow-up questionnaires every 6 months for 2 years, and at yearly intervals thereafter.

At baseline, 44% of patients were taking an oral glucocorticoid, 54% were taking a biologic, 74% were taking a conventional synthetic disease-modifying antirheumatic drug (csDMARD), 43% were taking a non-steroidal anti-inflammatory drug (NSAID), and 32% were taking an opioid. Throughout the follow-up period (median, 4 years), the prevalence of oral glucocorticoid use was 61%.

To test a hypothesis that the use of glucocorticoids may vary over time, the researchers examined the probability of their use throughout the follow-up period, and found that the probability of glucocorticoid use decreased with time:

• 55% probability of glucocorticoid use for the period from September 2001 to March 2005
• 47% from March 2005 to September 2008
• 42% from September 2008 to March 2012
• 39% from March 2012 to October 2015

Additional analysis showed that the hazard ratio (HR) of commencing oral glucocorticoid therapy decreased with the date of the patients’ baseline questionnaires, from March 2005 to September 2008 (HR, 0.42) to March 2012 to October 2015 (HR, 0.20). Furthermore, the HR of ceasing oral glucocorticoid therapy increased over time, from March 2005 to September 2008 (HR, 1.60) to March 2012 to October 2015 (HR, 3.56).

The study also found that increasing age was associated with decreased current glucocorticoid use, decreased commencement, and decreased cessation of these therapies. Greater disability was associated with a greater HR of commencing and a reduced HR of ceasing glucocorticoids, and higher pain scores were also associated with greater commencement.

There was no association with current glucocorticoid use and treatment with biologics, though the use of biologics, csDMARD, and NSAIDs were all associated with a reduced HR of commencing oral glucocorticoid therapy. Opioid use was associated with a reduced HR of both commencing and ceasing oral glucocorticoids.

While the study is limited by the fact that it relies on patient-reported data, the authors conclude that, among Australian patients with RA, glucocorticoid use has decreased over time, a finding that may represent growing awareness of the therapy’s potential for adverse events, as well as the greater availability of other therapeutic options.