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. 2017 Nov 15;19(1):253.
doi: 10.1186/s13075-017-1461-3.

Factors associated with oral glucocorticoid use in patients with rheumatoid arthritis: a drug use study from a prospective national biologics registry

Rachel J Black  1   2 , Susan Lester  3   4 , Rachelle Buchbinder  5   6 , Claire Barrett  7 , Marissa Lassere  8 , Lyn March  9 , Samuel Whittle  4 , Catherine L Hill  10   3   4
Affiliations

Factors associated with oral glucocorticoid use in patients with rheumatoid arthritis: a drug use study from a prospective national biologics registry

Rachel J Black et al. Arthritis Res Ther. .

Abstract

Background: Glucocorticoids (GCs) are used in ~ 60% of patients with rheumatoid arthritis (RA). Although disease-modifying, they also have significant adverse effects. Understanding factors associated with GC use may help minimise exposure. The aims of the present study were to describe oral GC use in RA; determine any change in use over time; and determine factors associated with oral GC use, commencement or cessation.

Methods: Adult patients with RA were identified in the Australian Rheumatology Association Database (ARAD), a national Australian registry that collects long-term outcome data from patients with inflammatory arthritis. Patients were categorised by their ARAD date of entry (DOE), with population-averaged logistic regression and transition state analysis used to determine any change in GC use over time. Fixed-effects panel regression was used to examine whether GC current use was associated with pain/arthritis activity/Health Assessment Questionnaire (HAQ) scores or medication use. Transition state analysis was used to assess whether these factors influenced the commencement or cessation of GCs.

Results: A total of 3699 patients with RA completed a baseline ARAD questionnaire (73% female, mean age 57 years). The probability of GC use decreased over time according to ARAD DOE: September 2001 to March 2005, 55% (95% CI 52-58%); March 2005 to September 2008, 47% (45-49%); September 2008 to March 2012, 42% (39-45%); and March 2012 to October 2015, 39% (34-43%) (p < 0.001). Conventional synthetic disease-modifying anti-rheumatic drugs (OR 10.13; 95% CI 8.22-12.47), non-steroidal anti-inflammatory drugs (1.18; 1.02-1.37) and opioids (2.14; 1.84-2.48) were associated with GC current use, as were lower pain scores (0.94; 0.90-0.98), higher arthritis activity scores (1.09; 1.05-1.14) and poorer HAQ scores (1.52; 1.30-1.79). Use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) was not associated with GC current use (0.98; 0.83-1.15) or GC cessation (HR 0.87; 95% CI 0.75-1.01), but it was associated with GC commencement (0.54; 0.47-0.62).

Conclusions: The probability of oral GC use decreased over time, with reduced commencement and increased cessation of GCs. The modest effect of bDMARDs on GC cessation was not statistically significant.

Keywords: Drug use; Epidemiology; Glucocorticoids; Rheumatoid arthritis.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for ARAD has been obtained from 18 committees and organisations across Australia (Additional file 1). This study was approved by The University of Adelaide Office of Research Ethics, Compliance and Integrity (approval number H-2015-258). Written informed consent was obtained from all participants prior to their enrolment in ARAD.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The association between glucocorticoid (GC) use and date of Australian Rheumatology Association Database baseline questionnaire. a Average probability of oral GC use throughout follow-up, according to date of baseline questionnaire. b The HR of commencing and ceasing an oral GC according to date of baseline questionnaire (HRs are relative to the first time point)
Fig. 2
Fig. 2
Transition state analysis of factors associated with the commencement and cessation of an oral glucocorticoid (GC). a Two transition states of interest are shown: (1) off oral GC at one time point, then on oral GC at the next time point (green triangle = oral GC is commenced), and (2) on oral GC at one time point, then off oral GC at the next time point (red circle = oral GC is ceased). The probability of commencing or ceasing an oral GC in any 12-month period is shown. b The association between age (decades) and sex (female) and the HR of commencing or ceasing an oral GC. c The association between Health Assessment Questionnaire (HAQ) score and pain score and the HR of commencing or ceasing an oral GC. d The association between concurrent medication use (biologic disease-modifying anti-rheumatic drug [bDMARD], conventional synthetic disease-modifying anti-rheumatic drug [csDMARD], non-steroidal anti-inflammatory drug [NSAID] and opioid) and the HR of commencing or ceasing an oral GC
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