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Abstract Number: 2606

Changes in Long-term GC Use Among Older Adults After New Diagnosis of Late-onset Rheumatoid Arthritis

Jiha Lee1, Jonathan Martindale1, Beth Wallace2, Namrata Singh3, Una Makris4 and Julie Bynum1, 1University of Michigan, Ann Arbor, MI, 2Michigan Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, 3University of Washington, Bellevue, WA, 4UT Southwestern Medical Center and Dallas VA, Dallas, TX

Meeting: ACR Convergence 2024

Keywords: Aging, Disease-Modifying Antirheumatic Drugs (Dmards), glucocorticoids, Medicare, rheumatoid arthritis

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Session Information

Date: Monday, November 18, 2024

Title: Abstracts: Health Services Research II

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Older adults with late-onset rheumatoid arthritis (LORA) receive less disease-modifying anti-rheumatic drugs (DMARDs), which is the standard of care. In contrast, long-term glucocorticoid (GC) use is common, despite its known adverse effects. The prevalence and relation of long-term GC use after LORA diagnosis with DMARD use is unknown.

Methods: In this cross-sectional study using 20% Medicare data from 2008-2017, we identified adults ≥66 years with a new diagnosis of LORA, with any DMARD use or at least two rheumatologist visits, and at least 12 months of follow-up data. Older adults were categorized as DMARD-exposed or DMARD-unexposed based on their use of any DMARD during the 12 months after LORA diagnosis (index date). For each quarter after the index date, long-term GC use was defined as having oral GC prescriptions for at least >30 days with a dose >5mg/day (prednisone equivalent). We compared the proportion of older adults with long-term GC use from Q1 to Q4 by DMARD exposure status. We performed multivariable logistic regression for factors associated with persistent GC use, defined as long-term GC use in Q2-Q4.

Results: We identified 15,425 older individuals with incident LORA who met the inclusion criteria. Two-thirds (62.5%) were DMARD-exposed with 75% starting a DMARD within 3 months of the index date. The DMARD-exposed, compared to the DMARD-unexposed, were younger (mean age 74.5 [SD 6.3] vs 76.1 [SD 7.0], p< 0.05), less predominantly female (73.4% vs 74.4%, p< 0.05), had more low-income subsidies (25.5% vs 22.5%, p< 0.05), more frequent rheumatology visits(p< 0.05) and fewer comorbidities (p< 0.05) (Table 1). Between Q1 and Q4, the proportion of older adults on long-term GC use was lowered from 43 to 24% (∆19%) among the DMARD-exposed and from 25 to 17% (∆8%) among the DMARD-unexposed (Figure 1). During the follow-up period, DMARD-exposed and DMARD-unexposed older adults with long-term GC use did not differ in their average daily dose (mg/day prednisone equivalent) (9.7 [SD 5.7] vs 9.4 [SD 8.4], p=0.31). One year after LORA diagnosis, 14% of the DMARD-exposed and 10% of the DMARD-unexposed were persistent GC users. In mixed-effects logistic models adjusting for clustering within a provider along with age, sex, race/ethnicity, year of the index date, rheumatologist visits and clustering within providers, and stratified by DMAD treatment, persistent GC use was associated with low-income subsidy status among the DMARD-exposed and with greater comorbidity burden among DMARD-unexposed, (Table 2).

Conclusion: More DMARD-exposed older adults reduce long-term GC use than DMARD-unexposed. Persistent GC use is common regardless of DMARD status, suggesting substandard treatment. Among the DMARD-exposed, persistent GC use may be related to financial barriers limiting access to high-cost biologic DMARD therapy, whereas among the DMARD-unexposed, it may be related to a greater comorbidity burden that limits the use of steroid-sparing DMARD use. Further studies are needed to optimize DMARD use and reduce GC in LORA.

Supporting image 1

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Disclosures: J. Lee: None; J. Martindale: None; B. Wallace: None; N. Singh: None; U. Makris: None; J. Bynum: None.

To cite this abstract in AMA style:

Lee J, Martindale J, Wallace B, Singh N, Makris U, Bynum J. Changes in Long-term GC Use Among Older Adults After New Diagnosis of Late-onset Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/changes-in-long-term-gc-use-among-older-adults-after-new-diagnosis-of-late-onset-rheumatoid-arthritis/. Accessed .
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