Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort

Abstract

ObjectiveTo explore the 7-year tolerability profile of glucocorticoids (GC) for early rheumatoid arthritis (RA).MethodsWe examined data for 602 patients with RA from the early arthritis Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (<6 months disease duration) stratified into two groups: with or without GC treatment at least once during follow-up (median 7 years (IQR 0.038–7.65)). The main outcome was a composite of death, cardiovascular disease (including myocardial ischaemia, cerebrovascular accident and heart failure), severe infection and fracture.ResultsAmong the 602 patients with RA (476 women (79%), mean age 48±12 years), 386 with GC (64.1%) received low-dose prednisone (mean 3.1±2.9 mg/day for the entire follow-up): 263 started GC during the first 6 months (68%), and the mean duration of total GC treatment was 1057±876 days. As compared with patients without GC (216 (35.9%)), those with GC showed greater use of non-steroidal anti-inflammatory drugs, synthetic and biological disease-modifying antirheumatic drugs and had more active disease disability, higher C reactive protein and anticitrullinated protein antibody levels. Among 65 events (7 deaths, 14 cardiovascular diseases, 19 severe infections and 25 fractures), 44 and 21 occurred in patients with and without GC (p=0.520). Infections were more frequent, although not significantly, in patients with than without GC (p=0.09). On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).ConclusionsThis 7-year analysis of the ESPOIR cohort supports the good safety profile of very low-dose GC for early active RA.

Long-term treatment with low dose glucocorticoids in Rheumatoid Arthritis: New tricks of an old drug

“…9 However, new data concerning GC safety came from the recently published ESPOIR cohort study, where RA patients with low-dose GC treatment displayed, in a 7-year analysis, approximately the same safety profile as patients without GC. 10 As it was expected, patents on GC (n=368) had more aggressive disease compared to patents without GC (greater use of NSAIDs, csDMARDs and bDMARDs, more active disease and more disability), and showed numerically a higher number of total adverse events (n= 44 vs 21) and infections (n=16 vs 3), compared to patients without GC exposure; the difference was not statistically significant (p=0.520 and p=0.09 respectively). In a further weighted Cox proportional-hazards analysis, composite outcomes do not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).…”

Glucocorticoids in rheumatoid arthritis: the picture is shaping up

“…This assumption is backed by both the published EULAR Task Force work1 and the real-life data by Roubille et al 8…”

“…For example, the data reported by Roubille et al 8 show that 64% of RA patients received low-dose prednisone for the entire follow-up. The mean duration of total GC treatment was 1057±876 days, which is much longer than the recommended maximum period of 6 months.…”

“…This primarily results from thorough analyses of accumulated data in order to update recommendations, but there are also new and often qualitatively better data coming in to enrich our knowledge. A very good example of the latter is the work by Roubille et al 8. These authors report carefully collected 7-year data from a prospective multicentre observational cohort of patients with early arthritis (ESPOIR).…”

Glucocorticoids in rheumatoid arthritis: current status and future studies

“…In the French ESPOIR cohort of patients with early arthritis, 45% started GCs during the first 6 months and more than 50% received GCs at least once over 5 years after inclusion 14. Overall, the dose of GCs received during follow-up was very low, the mean was 3.1±2.9 mg/day 15. In the Canadian CATCH cohort of patients with RA, 42% were considered GCs users and the median oral daily dose was 5 mg (IQR 2.5–10) 16…”