Risk of Serious Infection, Glucocorticoid Use Are Linked Among Patients With RA

Even at doses of 5 mg or less per day, glucocorticoids are associated with a small but significant risk of serious infection among patients with rheumatoid arthritis (RA), according to findings of a new study.

“Clinicians should balance the benefits of low-dose glucocorticoids with this potential risk,” the researchers advised.

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The retrospective cohort study included adults with RA receiving a stable disease-modifying antirheumatic drug (DMARD) regimen for more than 6 months. Using Medicare claims data, the researchers investigated glucocorticoid dose and incidence of hospitalization for serious infections among 172,041 patients. Using Optum’s deidentified Clinformatics Data Mart database, the researchers investigated the same relationship among an additional 44,118 patients.

According to the study, 47.1% of Medicare patients and 39.5% of Optum patients were receiving glucocorticoids after 6 months of stable DMARD use. Among both populations, glucocorticoid use was associated with a dose-dependent increase in serious infection risk.

Compared with an 8.6% one-year cumulative incidence of hospitalized infection among Medicare patients not receiving glucocorticoids, the 1-year cumulative incidence of hospitalized infection was 11.0% for those receiving a daily glucocorticoid dose of 5 mg or less, 14.4% for those receiving a daily glucocorticoid dose greater than 5 mg to 10 mg, and 17.7% for those receiving a daily glucocorticoid dose greater than 10 mg. 

Among Optum patients, the 1-year cumulative incidence of hospitalized infection for those not receiving glucocorticoids was 4.0%. With a daily glucocorticoid dose of 5 mg or less, the 1-year cumulative incidence of hospitalized infection was 5.2%. With a daily glucocorticoid dose of greater than 5 mg to 10 mg, the hospitalized infection incidence was 8.1%, rising to 10.6% with a daily glucocorticoid dose above 10 mg.

—Jolynn Tumolo

Reference:

George MD, Baker JF, Winthrop K, et al. Risk for serious infection with low-dose glucocorticoids in patients with rheumatoid arthritis: a cohort study. Ann Intern Med. Published online September 22, 2020. https://doi.org/10.7326/M20-1594