A Closer Look at the Risk for Severe Outcomes With Low-Dose Glucocorticoids for RA

The 10-year tolerability profile of glucocorticoid use in RA patients starting early in the course of their disease was studied.

The risk for severe outcomes with low-dose glucocorticoids in patients with rheumatoid arthritis (RA) increases over time, particularly after 6 years and up to 10 years of treatment, study findings published in Rheumatology suggest.

This study analyzed 10-year outcomes data obtained from the prospective, observational ESPOIR cohort, which included patients with early arthritis (mean age, 47.5 years) from 14 French rheumatology centers. The investigators identified patients who received low-dose glucocorticoids at least once during follow-up (n=397) and patients who did not receive glucocorticoids (n=211). Both groups were compared in regard to the primary outcome, which was a composite of death, cardiovascular disease (CVD), severe infection, and fracture.

Overall, the mean follow-up duration was 8.66 years. The mean cumulative prednisone dose in the patients who received low-dose glucocorticoids during follow-up was 8468 mg, and the mean duration of treatment was 44.6 months.

A total of 95 events were reported, including 10 deaths, 18 cases of CVD, 32 fractures, and 35 severe infections. In the univariate analysis, receipt of glucocorticoids was associated with significantly more events (n=71) than no glucocorticoid treatment (n=24; P =.035). Approximately 24% of patients who received a cumulative prednisone dose of greater than 8.4 g during follow-up experienced the primary outcome (P =.007), including 7.9% who had CVD (P =.001) and 9.9% who had severe infections (P =.024).

In a weighted Cox time-dependent analysis, the risk for events was associated with glucocorticoid use (P <.001), age, hypertension, and erythrocyte sedimentation rate. The risk for severe outcomes with low-dose glucocorticoids increased between the initial follow-up visit at 1 year (hazard ratio [HR], 0.46; 95% CI, 0.23-0.90) and the follow-up visit at 10 years (HR, 6.83; 95% CI, 2.29-20.35).

A limitation of this study included its observational nature, which meant the study may have featured potential confounders that were not adjusted for in the analyses.

Based on these findings, the investigators concluded that “the current expert consensus that glucocorticoids should be used at the lowest possible dose and for the shortest duration” is supported by the results of this study research, the investigators believe. The investigators added the findings support “integrated and sustained screening and management of glucocorticoid-related complications in” patients with RA.

Disclosure: This research was supported by several pharmaceutical companies. Please see the original reference for a full list of disclosures.


Roubille C, Coffy A, Rincheval N, et al. Ten-year analysis of the risk of severe outcomes related to low-dose glucocorticoids in early rheumatoid arthritis. Rheumatology (Oxford). Published online December 15, 2020. doi:10.1093/rheumatology/keaa850