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Rheumatoid arthritis: short-term dose and duration-dependent glucocorticoid risk for cardiovascular events in glucocorticoid-naive patients


Rheumatoid arthritis ( RA ), along with glucocorticoid use, is associated with cardiovascular disease.
Cardiovascular safety of glucocorticoids in rheumatoid arthritis is controversial and may be related to dose and duration of use.

The aim of a study was to determine if initiating glucocorticoids in steroid-naive patients with rheumatoid arthritis would increase cardiovascular event ( CVE ) risk in a dose and duration-dependent manner over short-term intervals.

Data from the CorEvitas ( formerly Corrona ) RA registry were analyzed. The researchers collected data from between Oct. 1, 2001, and March 31, 2018, identifying 48,535 enrolled adults.

19 902 patients met criteria. 1106 cardiovascular events occurred ( 1.66/100 person-years ).

Increased adjusted HRs ( aHR ) occurred at current doses of greater than or equal to 5–9 mg 1.56 ( 1.18–2.06 ) and greater than or equal to 10 mg 1.91 ( 1.31–2.79 ), without increased risk at 0–4 mg 1.04 ( 0.55–1.59 ).

Cumulative dose over preceding 6 months showed increased aHR at 751–1100 mg 1.43 ( 1.04–1.98 ) and more than 1100 mg 2.05 ( 1.42–2.94 ), without increased risk at lower doses; duration of use over preceding 6 months exhibited increased aHR for more than 81 days of use 1.54 ( 1.08–2.32 ), without increased risk at shorter durations.

One-year analyses were consistent.

In conclusion, over preceding 6-month and 1-year intervals, initiating glucocorticoids in steroid-naïve patients with rheumatoid arthritis is associated with increased risk of cardiovascular events at daily doses 5 mg or more and increased cumulative dose and duration of use.
No association with risk for cardiovascular events was found with daily Prednisone of less than or equal to 4 mg or shorter cumulative doses and durations. ( Xagena )

Ocon AJ et al, Ann Rheum Dis 2021; Online ahead of print

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