Background/Purpose: Prior descriptive work revealed high rates of long term (≥3 months) glucocorticoid (GC) utilization in a commercially insured incident RA cohort [1]. We aim to evaluate associations between patient factors and long term GC utilization in this cohort.

Methods: Using OptumInsight^TM claims data, we identified 9600 adults with ≥2 RA office visits ≥30 days apart between 2010-2014, ≥1 DMARD pharmacy claim, and ≥1 year prior to RA diagnosis with no RA medical claims or DMARD pharmacy claims (“washout”) (Fig. 1). We used a Cox proportional hazards regression model to examine long term GC use, defined as 90 days’ GC supply filled within 1 year of first RA claim (study period), adjusted for patient demographics, comorbidity, and overall and RA-related healthcare utilization. We assessed demographics, comorbidity, and overall healthcare utilization over a washout year before first RA claim. We performed a sensitivity analysis using a dose-based definition, 900mg prednisone equivalent filled during study period (representing 10mg/day for 3 months).

Results: During the study period, 2933 (31%) patients filled 90 days’ GC supply, and 3000 (31%) filled 900mg. Baseline patient characteristics are presented in Table 1. Characteristics independently associated with 90 days’ GC supply include male sex (adjusted hazard ratio [HR] 1.4, p< 0.001), age >60 years (HR 1.2, p=0.005), having ≥6 Elixhauser comorbidities (HR 1.3, p< 0.001), taking GC prior to RA diagnosis (HR 2.0, p=0.001), use of biologic DMARD (HR 1.3, p< 0.001), and seeing a rheumatologist ≤3 months from RA diagnosis, relative to >3 months (HR 1.3, p=0.006) (Table 2). Age groups 18-40 (HR 0.8, p< 0.001) and 41-50 (HR 0.9, p=0.002) were associated with lower risk of the outcome. Race, year of RA diagnosis, number of pre-diagnosis office visits and prescription fills, and time to first DMARD fill (if ≤12 months) were not significantly associated with the outcome. Findings were similar for the dose-based outcome; association with ≤3 months to rheumatologist was attenuated but significant (HR 1.10, p=0.006) (Table 2).

Conclusion: In this commercially insured incident RA cohort, seeing a rheumatologist within 3 months of diagnosis was independently associated with long term GC utilization, while time to first DMARD (within 12 months) was not. This association, suggested by our prior descriptive work[1], held after controlling for claims-based measures of RA severity like DMARD use, biologic use, and GC use prior to diagnosis. Prior work supports the other factors associated with GC use in this cohort (i.e. male sex, older age, comorbidity)[2]. Further work to evaluate potential associations between rheumatologist access and long term GC utilization is warranted.

1. Wallace B, Lin P, Kamdar N, Noureldin M, Hayward R, Fox DA, et al. Patterns of Glucocorticoid Use and Provider-Level Variation in a Commercially Insured Incident Rheumatoid Arthritis Population [abstract]. Arthritis & rheumatology. 2018; 70(Suppl. 10).
2. Overman RA, Yeh JY, Deal CL. Prevalence of oral glucocorticoid usage in the United States: a general population perspective. Arthritis care & research. 2013 Feb; 65(2):294-298.

table 1 optum modeling abstract

table 2 optum modeling abstract

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-characteristics-associated-with-long-term-glucocorticoid-use-in-a-commercially-insured-incident-ra-cohort/