Ten-year analysis of the risk of severe outcomes related to low-dose glucocorticoids in early rheumatoid arthritis

Objectives. To explore the 10-year tolerability profile of glucocorticoids (GC) use in patients with early RA. Methods. Analysis of 10-year outcome from the early arthritis ESPOIR cohort. Patients were stratified in two groups, without or with GC treatment at least once during their follow-up. The primary outcome was a composite of deaths, cardiovascular diseases (CVD), severe infections and fractures. The weighted Cox time-dependent analysis model was used with inverse probability of treatment weighting (IPTW) propensity score method. Results. Among the 608 patients [480 women, mean age of 47.5 (12.1)years], 397 (65%) received low-dose GC [median 1.9 mg/day (IQR 0.6-4.2), mean cumulative prednisone dose 8468 mg (8376), mean duration 44.6 months (40.1)]. In univariate analysis, over 95 total events (10 deaths, 18 CVDs, 32 fractures and 35 severe infections), patients taking GC experienced more events (n = 71) than those without GC (n = 24) (P =0.035). Highest cumulative exposure of GC (>= 8.4g) was associated with highest risk of occurrence of the primary outcome (24.3%, P =0.007), CVDs (7.9%, P =0.001) and severe infections (9.9%, P =0.024). The risk of events over time was significantly associated with GC, age, hypertension and ESR. The risk associated with GC treatment increased between the first follow-up visit [hazard ratio (HR) at 1 year = 0.46, 95% CI: 0.23, 0.90] and 10 years (HR =6.83, 95% CI: 2.29, 20.35). Conclusion. The 10-year analysis of this prospective early RA cohort supports a dose and time-dependent impact of low-dose GC treatment, with a long-term high risk of severe outcomes.

Automated summary

This study explored the 10-year tolerability profile of glucocorticoids (GC) use in patients with early RA, finding that patients with the highest cumulative exposure of GC had the highest risk of severe outcomes. The risk associated with GC treatment increased over time, indicating a long-term impact of low-dose GC treatment.