DMARDs Mitigate Increased Mortality With Prednisone Use in RA

HealthDay News – A large, longitudinal cohort of patients with rheumatoid arthritis (RA) utilized a propensity score to show an increased risk of mortality associated with prednisone use. This increased mortality risk negated previously described survival advantages associated with methotrexate use in RA. These findings were reported in a study published in  Arthritis Care & Research.

Mary Chester Wasko, MD, from the Allegheny Health Network in Pittsburgh, Pa., and colleagues conducted a prospective study involving 5626 patients with RA followed for up to 25 years. The authors examined the risk of death associated with prednisone use alone and combined treatment of prednisone with methotrexate (MTX) or sulfasalazine.

The researchers found that during a median follow-up of 4.97 years, 11.8% of patients died. Prednisone use was associated with increased risk of death in a multivariate, propensity-adjusted model (hazard ratio, 2.83; 95% confidence interval, 1.03 to 7.76). 

High Yield Clinical Pearls

  • Prednisone use was associated with a increased mortality risk in patients with RA, even after accounting for potential treatment selection bias

There was a significant interaction between prednisone us e and MTX use (P = 0.03), with the risk of death attenuated for patients treated with prednisone and MTX (hazard ratio, 0.99; 95%confidence interval, 0.18 to 5.36). The protective association of MTX with mortality was weakened with combination treatment. Similar results were seen for sulfasalazine.

“Prednisone use was associated with a significantly increased risk of mortality in patients with RA,” the authors write. “This association was mitigated by concomitant disease-modifying antirheumatic drug use, but combined treatment also negated the previously reported beneficial association of MTX with survival in RA.”

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Chester wasko M, Dasgupta A, Ilse sears G, Fries JF, Ward MM. Prednisone Use and Risk of Mortality in Patients With Rheumatoid Arthritis: Moderation by Use of Disease-Modifying Antirheumatic Drugs. Arthritis Care Res (Hoboken). 2016;68(5):706-10.