Incidence and Risk of Glucocorticoid‐Associated Adverse Effects in Patients With Rheumatoid Arthritis

Wilson, J. K.; Sarsour, Khaled; Gale, Sara; Pethö‐Schramm, Attila; Jick, Susan S.; Meier, Christoph

doi:10.1002/acr.23611

Cited by 84 publications

(79 citation statements)

References 35 publications

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“…In contrast to our results, the other study, using UK (Clinical Practice Research Datalink (CPRD) data, showed 35–60% higher incidence rates of GI perforation and bleeding among patients with RA, even after stratifying for having received GC prescriptions during follow-up. 2 It is possible that the difference in outcome definitions explains the discrepancy, as we noted a tendency towards higher total (upper plus lower) GI perforation risk among bionaïve patients with RA (the largest RA cohort) compared to general population controls (online supplementary figure 2). Regardless, it seems likely that higher exposure to GCs among patients with RA is an important contributor to the overall increased risk of GI perforation.…”

Section: Discussionmentioning

confidence: 82%

“…Patients with rheumatoid arthritis (RA) have been reported to be at an increased risk of gastrointestinal (GI) complications compared to patients who did not have RA. 1 2 Among these, GI perforations are rare but potentially lethal, and it is unclear to what extent a risk increase may be caused by inflammation or other RA processes, or rather by the treatments used in RA.…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal perforations in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs in Sweden: a nationwide cohort study

et al. 2020

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ObjectivesTo compare incidence rates of gastrointestinal (GI) perforations between patients with RA and the general population, and between patients treated with tumour necrosis factor inhibitors (TNFi) and non-TNFi biologics.MethodsIn this nationwide cohort study, a total of 63 532 patients with RA, with 26 050 biological treatment episodes (TNFi, rituximab, abatacept or tocilizumab) and 76 304 general population controls, were followed between 2009 and 2017 until the first outcome event. The main outcome was hospitalisation or death due to lower GI perforations, identified according to a prespecified list of ICD-10 (International Classification of Diseases, 10th revision) codes. Inverse probability of treatment weighting was used for adjustment.ResultsThe sex-standardised and age-standardised incidence rates of lower GI perforations were 1.1 (95% CI 1.0 to 1.3) events per 1000 person-years among general population controls, 1.6 (1.5–1.7) among bionaïve patients and ranged from 1.8 (1.4–3.6) (TNFi) to 4.5 (2.7–10.4) (tocilizumab) among biologics-treated patients. After adjustment for glucocorticoid use, the risk in bionaïve, TNFi-treated, abatacept-treated or rituximab-treated patients with RA was no longer different from the general population, while for tocilizumab it remained significantly higher. Comparing tocilizumab to TNFi, the adjusted HR for lower GI perforations was 2.2 (1.3–3.8), corresponding to one additional GI perforation per 451 patient-years treated with tocilizumab instead of TNFi.ConclusionTocilizumab was associated with a higher risk of lower GI perforations compared with alternative biologics. In absolute numbers, the risk remained low on all biologics commonly used to treat RA, but the accumulated evidence across settings and outcome definitions supports that this risk should be considered in treatment guidelines for RA.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Gastrointestinal perforations in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs in Sweden: a nationwide cohort study

et al. 2020

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“…Notably, long term use of oral steroids for any individual (whether or not they have RA) was associated with an 82% and 58% higher cardiovascular risk in women and men, respectively 20 , which was likely in part related to the detrimental effects of these drugs on cardiometabolic factors. For example, corticosteroid use increases the risk of type 2 diabetes, hypertension, thrombotic stroke or myocardial infarction and death in patients with RA 112,113 .…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Overall, these findings highlight the importance of a holistic, multisystem approach to the management of RA and PsA, not only to lessen clinically evident joint and/or skin-associated disease but also to improve life expectancy and quality of life. Corticosteroids  In the general population, corticosteroid use is associated with increased SBP, weight, insulin resistance, cardiovascular risk and all-cause mortality 112,113 .…”

Section: Small-molecule and Biologic Therapiesmentioning

confidence: 99%

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

et al. 2019

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“…Based on previous reports on the risks related to infections and medications, including glucocorticoid, csDMARDs, and bDMARDs [6,15,17,36,39,40] [35,41], a dose-related glucocorticoid was reported to increase the risk of infection, whereas csDMARDs were reported to reduce the risk and mortality in RA [42] [15,43]. Treatment with glucocorticoids raised the incidence and hazard of adverse effects in RA patients, such as diabetes mellitus, osteoporosis, thrombotic stroke, CVD, serious infection, and death [44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

Fujiwara

Tokuda

Momii

et al. 2020

Preprint

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Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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Incidence and Risk of Glucocorticoid‐Associated Adverse Effects in Patients With Rheumatoid Arthritis

Abstract: RA patients had an increased incidence of GC-related AEs. Increasing cumulative and average daily GC doses were found to be associated with increasing risk of developing an AE. This article is protected by copyright. All rights reserved.

Cited by 84 publications

References 35 publications

Gastrointestinal perforations in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs in Sweden: a nationwide cohort study

Gastrointestinal perforations in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs in Sweden: a nationwide cohort study

Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions

Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

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