According to study results published in Seminars in Arthritis and Rheumatism, almost three-quarters of patients with rheumatoid arthritis (RA) are prescribed glucocorticoids during the peridiagnostic period, in which >30% received long-term glucocorticoids and 37% received high-dose glucocorticoids. Rheumatologists typically prescribed glucocorticoids, but their overall prescribing patterns varied widely.
The investigators of this retrospective cohort study sought to characterize how healthcare providers prescribe glucocorticoids to commercially insured patients with a new diagnosis of RA.
The investigators identified 9221 adults, ages 18 to 65 years, from the national Optum® Clinformatics® database who were diagnosed with RA between 2010 and 2014. They calculated dispensing patterns for oral glucocorticoids for the study period (3 months prediagnosis through 12 months postdiagnosis) and stratified per calendar quarter and prescriber specialty (rheumatologist, primary care provider, or other). Among individual rheumatologists, researchers examined variation in prescribing practices by the quarterly distribution of per-patient dose, days’ supply, and daily dose and analyzed dispensing trends by ranking these parameters and dividing into quartiles across quarters.
During the study period, 6717 (72.8%) patients filled ≥1 glucocorticoid prescription, and 2890 (31.3%) patients received a ≥3-month supply of glucocorticoids. In the group receiving ≥90 days of glucocorticoids, the median daily dose was 10 mg, and the median days’ supply measured 189 days. The proportion of patients who filled a glucocorticoid prescription during the first 3 months after diagnosis was 52.6%, and the proportion who filled glucocorticoid prescriptions during the remaining study period ranged from 35.7% in the second quarter (Q2) to 29.2% in the fourth quarter (Q4). Whereas glucocorticoid use declined between Q2 and Q4, the median daily dose (≥10 mg) and days’ supply (≥30 days) were consistent. Rheumatologists prescribed the most glucocorticoids, dispensing a median per-quarter daily dose of 10 mg and days’ supply of 43 to 60 days; however, the prescribing practices of rheumatologists varied widely across the full study period.
Limitations to the study included the use of commercial claims data in which the investigators were unable to fully account for disease activity, track individual providers’ glucocorticoid prescribing patterns, or track individual patients through the study period.
In commercially insured patients with incident RA, a glucocorticoid prescription of ≥10 mg/d lasting for months was common, and glucocorticoid use persisted a year postdiagnosis in 18% to 24% of patients. Glucocorticoids are typically prescribed by rheumatologists; however, wide variation in dose and days’ supply has been observed.
Wallace BI, Lin P, Kamdar N, et al. Patterns of glucocorticoid prescribing and provider-level variation in a commercially insured incident rheumatoid arthritis population: a retrospective cohort study [published online September 7, 2019]. Semin Arthritis Rheum. doi: 10.1016/j.semarthrit.2019.09.002