Low-dose Glucocorticoid Use Does Not Reduce Biologic Use in Early RA, Nor Do Biologics Reduce the Need for Glucocorticoids.

Abstract

The persistent use of glucocorticoids (GC) has been associated with higher risks of osteoporosis, fractures, infection, and cardiovascular events. Although more costly, biologic disease-modifying antirheumatic drug (bDMARD) use could limit complications from prolonged exposures to GC in those patients at risk. The question arises as to whether this is occurring in settings of usual care. Patterns of bDMARD and GC use have rarely been studied in large populations, and factors that predict the initiation or persistent use of either or both are relevant to patients, providers, and payers. In this edition of The Journal , George, et al 1 examined predictors associated with time to first bDMARD use from the time methotrexate (MTX) was first initiated (index date). GC users were those who had started GC within 90 days of the index date, and used GC consistently over the 2-year study window. The study’s 17,415-person rheumatoid arthritis (RA) cohort of incident MTX users, classified as RA using diagnostic codes, was treated between 2005 and 2016. Patients were identified from 3 linked US Veterans Affairs (VA) national administrative databases, and recorded data were used from real-world settings for 2 years from the index date. Initiation … Address correspondence to Dr. V.P. Bykerk, Hospital for Special Surgery, 535 East 70th St., New York, New York 10021, USA. E-mail: bykerkv{at}hss.edu