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Incidence and Risk of Glucocorticoid‐Associated Adverse Effects in Patients With Rheumatoid Arthritis
Author(s) -
Wilson Jessica C.,
Sarsour Khaled,
Gale Sara,
PethöSchramm Attila,
Jick Susan S.,
Meier Christoph R.
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23611
Subject(s) - medicine , rheumatoid arthritis , osteoporosis , incidence (geometry) , odds ratio , stroke (engine) , adverse effect , myocardial infarction , diabetes mellitus , cumulative incidence , confidence interval , cohort , surgery , endocrinology , mechanical engineering , physics , optics , engineering
Objective Using the UK Clinical Practice Research Datalink, we examined the incidence of glucocorticoid ( GC )‐related serious adverse events ( SAE s) in rheumatoid arthritis ( RA ) and non‐ RA patients and quantified the risk of SAE s in patients with RA . Methods We matched incident patients with RA to an age‐ and sex‐matched, non‐ RA comparison group of equal size. In a cohort analysis, we estimated incidence rates ( IR s) and IR ratios ( IRR s) for GC ‐related AE s (i.e., diabetes mellitus [ DM ], osteoporosis, fractures, glaucoma, hypertension, gastrointestinal [ GI ] perforation or bleeding, thrombotic stroke or myocardial infarction [ MI ], or death), stratified by GC use. We conducted a series of nested case–control analyses among patients with RA , evaluating the effects of increasing cumulative and average daily GC dose. Cases of each outcome were matched to controls for age, sex, and general practice. We calculated adjusted odds ratios ( OR s) with 95% confidence intervals (95% CI s) for each outcome. Results Patients with RA had a higher incidence for all investigated SAE s except glaucoma, compared to non‐ RA patients. IRR s were greater in those patients prescribed a GC than in those without. In patients with RA , GC s were associated with an elevated risk of DM (adjusted OR 1.33 [95% CI 1.14–1.56]), osteoporosis (adjusted OR 1.41 [95% CI 1.25–1.59]), thrombotic stroke or MI (adjusted OR 1.28 [95% CI 1.07–1.52]), serious infection (adjusted OR 1.28 [95% CI 1.11–1.48]), and death (adjusted OR 1.33 [95% CI 1.19–1.48]). There was a trend of increasing risk with increasing cumulative and average daily GC dose for all outcomes other than glaucoma, hypertension, and GI perforations or bleeding ( P < 0.05). Conclusion Patients with RA had an increased incidence of GC ‐related AE s. Increasing cumulative and average daily GC doses were found to be associated with an increasing risk of developing an AE .