medwireNews: Steroid-naive patients with rheumatoid arthritis (RA) have a dose- and duration-dependent increased risk for cardiovascular (CV) events following glucocorticoid initiation, real-world study data show.
Anthony Ocon (University of Rochester Medical Center, New York, USA) and colleagues report that “[r]elative cardiovascular safety was found with <5 mg of prednisone-equivalent daily dose and lower cumulative doses and durations of use.”
However, they caution: “Physicians should be aware […] that low-dose and short-term use of glucocorticoids may increase risk of cardiovascular events when prescribing for treatment of RA in a treat-to-target approach.”
Ocon and team analyzed data from 19,902 patients enrolled in the CorEvitas RA registry. During more than 16 years of follow-up, 12.6% initiated glucocorticoids and 1106 CV events were reported, giving a rate of 1.66 cases per 100 person–years.
After adjustment for multiple potential RA- and CV-related confounders, the investigators observed that glucocorticoid use at a dose of 5–9 mg/day in the preceding 6 months was associated with a significant 1.56-fold increased risk for an incident CV event compared with no glucocorticoid use.
When the dose increased to 10 mg/day or higher, the excess CV event risk increased a significant 1.91-fold.
In addition, a cumulative glucocorticoid dose of 751–1100 mg over the preceding 6 months was associated with a significant 1.43-fold increased risk for a CV event relative to no glucocorticoid treatment, while the hazard ratio was 2.05 when the cumulative glucocorticoid dose was above 1100 mg.
The researchers also identified an increased CV event risk with prolonged duration of glucocorticoid use over the preceding 6 months. In this case, use for between 81 and 160 days was associated with a significant 54% higher risk for a CV event versus no use.
Similar results were observed when the preceding period was extended to 1 year.
Writing in the Annals of the Rheumatic Diseases, Ocon and co-authors stress the clinical importance of their finding that, even after adjustment for CV risk factors and RA duration and treatment, there was “no increased risk for CV [events] with current prednisone-equivalent daily doses of <5 mg or cumulative doses of ≤750 mg over the preceding 6 months or ≤1100 mg over the preceding 1 year.”
They also “found no increased risk with duration of use ≤80 days over the preceding 6 months or ≤100 days over the preceding 1 year.”
The authors conclude: “We believe that our data demonstrate that [glucocorticoid] use should be tapered to a dose of <5 mg prednisone-equivalents as expeditiously as possible, while being aware of duration of use and cumulative dose.”
They add that clinicians should therefore “provide counselling and education of these findings when encountering a reluctance on the part of a pain-free patient to taper [glucocorticoids], or succumb to the temptation to simply increase the dose to make the patient feel better until their next visit.”
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