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Risk for Serious Infection With Low-Dose Glucocorticoids in Patients With Rheumatoid Arthritis : A Cohort Study.
George, Michael D; Baker, Joshua F; Winthrop, Kevin; Hsu, Jesse Y; Wu, Qufei; Chen, Lang; Xie, Fenglong; Yun, Huifeng; Curtis, Jeffrey R.
  • George MD; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.).
  • Baker JF; University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (J.F.B.).
  • Winthrop K; Oregon Health & Science University, Portland, Oregon (K.W.).
  • Hsu JY; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.).
  • Wu Q; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G., J.Y.H., Q.W.).
  • Chen L; University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., H.Y., J.R.C.).
  • Xie F; University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., H.Y., J.R.C.).
  • Yun H; University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., H.Y., J.R.C.).
  • Curtis JR; University of Alabama at Birmingham, Birmingham, Alabama (L.C., F.X., H.Y., J.R.C.).
Ann Intern Med ; 173(11): 870-878, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-2110823
ABSTRACT

BACKGROUND:

Low-dose glucocorticoids are frequently used for the management of rheumatoid arthritis (RA) and other chronic conditions, but the safety of long-term use remains uncertain.

OBJECTIVE:

To quantify the risk for hospitalized infection with long-term use of low-dose glucocorticoids in patients with RA receiving stable disease-modifying antirheumatic drug (DMARD) therapy.

DESIGN:

Retrospective cohort study.

SETTING:

Medicare claims data and Optum's deidentified Clinformatics Data Mart database from 2006 to 2015. PATIENTS Adults with RA receiving a stable DMARD regimen for more than 6 months. MEASUREMENTS Associations between glucocorticoid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability-weighted analyses, with 1-year cumulative incidence predicted from weighted models.

RESULTS:

247 297 observations were identified among 172 041 patients in Medicare and 58 279 observations among 44 118 patients in Optum. After 6 months of stable DMARD use, 47.1% of Medicare patients and 39.5% of Optum patients were receiving glucocorticoids. The 1-year cumulative incidence of hospitalized infection in Medicare patients not receiving glucocorticoids was 8.6% versus 11.0% (95% CI, 10.6% to 11.5%) for glucocorticoid dose of 5 mg or less per day, 14.4% (CI, 13.8% to 15.1%) for greater than 5 to 10 mg/d, and 17.7% (CI, 16.5% to 19.1%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids). The 1-year cumulative incidence of hospitalized infection in Optum patients not receiving glucocorticoids was 4.0% versus 5.2% (CI, 4.7% to 5.8%) for glucocorticoid dose of 5 mg or less per day, 8.1% (CI, 7.0% to 9.3%) for greater than 5 to 10 mg/d, and 10.6% (CI, 8.5% to 13.2%) for greater than 10 mg/d (all P < 0.001 vs. no glucocorticoids).

LIMITATION:

Potential for residual confounding and misclassification of glucocorticoid dose.

CONCLUSION:

In patients with RA receiving stable DMARD therapy, glucocorticoids were associated with a dose-dependent increase in the risk for serious infection, with small but significant risks even at doses of 5 mg or less per day. Clinicians should balance the benefits of low-dose glucocorticoids with this potential risk. PRIMARY FUNDING SOURCE National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Antirheumatic Agents / Glucocorticoids / Infections Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Language: English Journal: Ann Intern Med Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Arthritis, Rheumatoid / Antirheumatic Agents / Glucocorticoids / Infections Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Language: English Journal: Ann Intern Med Year: 2020 Document Type: Article