ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 50

Characteristics and Outcomes Associated with Early Corticosteroid Use in a Large Multicenter Canadian RA Cohort

Kathleen Andersen1, Daming Lin2, Susan J. Bartlett3,4, Gilles Boire5, Boulos Haraoui6, Carol Hitchon7, Shahin Jamal8, Edward C. Keystone9, Janet E. Pope10, Diane Tin11, J Carter Thorne12, VP Bykerk13,14 and CATCH Investigators, 1Hospital for Special Surgery, New York, NY, 2Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 3Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, 4Medicine , Divisions of Clinical Epidemiology, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, 5Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC, Canada, 6Institut de Rhumatologie, Montreal, QC, Canada, 7Department of Rheumatology, University of Manitoba, Winnipeg, MB, Canada, 8Vancouver Coastal Health, Vancouver, BC, Canada, 9Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 10University of Western Ontario, London, ON, Canada, 11The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 12University of Toronto, Toronto, ON, Canada, 13Rheumatology, Hospital for Special Surgery, New York, NY, 14Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , , , ,

Session Information

Date: Sunday, November 8, 2015

Title: Epidemiology and Public Health Poster I: Comorbidities and Outcomes of Systemic Inflammatory Diseases

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Synthetic glucocorticoids (steroids) are commonly used in RA to rapidly inhibit pro-inflammatory cytokines. They are frequently used as “bridge therapy”, quickly dampening down the immune response allowing slower-acting DMARDs time to effectively reduce disease activity. Early steroid use is variable. The purpose of this study was to compare characteristics and outcomes over time of patients exposed to early steroid use in a large early RA cohort. 

Methods: Data are from the first 18 months of patients entering and followed in CATCH (Canadian early ArThritis CoHort). Inclusion criteria were symptoms ≤12-months, fulfillment of ACR 1987 and/or 2010 RA criteria and steroid use was recorded. Patients were stratified based on steroid use within first 3 months of study entry. Sociodemographic and RA characteristics between groups at baseline and selected outcomes (CDAI, DAS28, MD global, RAPID III and biologic starts) at 3, 6, 12, and 18 months were compared using t-test. Outcomes for patients receiving no, intra-articular/intra-muscular (IA/IM) only, oral only (PO), or both forms of steroids were evaluated at each time point.

Results: At baseline, patients who received steroids were older and less likely to be employed but not statistically different by race, weight, or SES. Steroid users had shorter symptom duration, higher acute phase reactants, and reported more pain and fatigue (Table 1). Both patient-reported outcomes (PROs: patient global, HAQ, RAPID III, RADAI pain and VR12) as well as clinically reported observations (CLINROs: MD global, joint counts, and DAS28) were significantly worse in those who received steroids. Steroid use was more frequent in participants enrolled at large study sites (>100 enrolled) and in those concomitantly taking MTX. Composite measures are worse over time in patients receiving both forms of steroids at months 3-12, and there is a trend toward more biologic use thereafter (Table 2).

Conclusion : Patients receiving steroids within the first 3 months tend to be older, with shorter disease duration and higher indicators of disease activity. These data suggest steroids are being used to intensify treatment in patients with poor prognostic factors to control more active disease. Despite early use of both parenteral and oral steroids, biologic use in the long term is still required in patients with more active disease at baseline.

 

Table 1: Characteristics of participants by steroid use in first three months.

 

None

IA/IM only

Oral only

Oral + IA/IM

Sig

N

697

436

392

164

 

Sociodemographics

 

 

 

 

 

Age (yrs)

51.9 (14.1)

52.9 (15.6)

56.4 (15.5)

56.1 (14.1)

<0.0001

Female sex

528 (76%)

335 (77%)

281 (72%)

106 (65%)

0.01

BMI (kg/m2)

28.0 (6.5)

28.2 (6.4)

28.3 (5.8)

29.2 (5.3)

0.492

Caucasian, n (%)

563 (81%)

349 (80%)

324 (83%)

139 (85%)

0.464

Living alone, n (%)

103 (15%)

58 (13%)

62 (16%)

19 (12%)

0.542

Employed, n (%)

415 (60%)

242 (56%)

194 (49%)

73 (45%)

<0.0001

Education <= HS

288 (43%)

189 (45%)

165 (44%)

84 (53%)

0.19

Income >$50,000/year

229 (47%)

125 (39%)

98 (43%)

39 (37%)

0.076

Currently Smoking

117 (17%)

76 (17%)

68 (17%)

25 (15%)

0.934

Co-morbidities

524 (76%)

332 (76%)

308 (79%)

127 (78%)

0.637

Comorbidities

2.0 (2.0)

2.1 (2.1)

2.2 (2.0)

2.3 (2.1)

0.254

Site enrolled > 100

413 (59%)

383 (88%)

233 (59%)

149 (91%)

<0.0001

Clinical

 

 

 

 

 

     Symptom duration (mo)

6.8 (4.1)

5.4 (3.0)

5.5 (3.3)

5.4 (3.6)

<0.0001

Tender Joints (28)

7.6 (5.9)

9.7 (6.7)

9.5 (7.2)

9.7 (7.2)

<0.0001

Swollen Joints (28)

6.7 (5.4)

9.1 (6.2)

7.8 (6.3)

8.9 (6.5)

<0.0001

Morning stiffness ≥60 min

433 (63%)

237 (54%)

265 (68%)

106 (65%)

<0.0001

Patient Global (0-100 mm)

53.6 (29.1)

66.7 (25.8)

57.3 (29.6)

64.6 (29.8)

<0.0001

MD Global (0-100 mm)

45.4 (24.7)

54.8 (23.0)

50.6 (24.4)

52.9 (25.2)

<0.0001

Pain (0-10 cm)

5.0 (2.8)

6.5 (2.6)

5.5 (2.8)

6.1 (2.8)

<0.0001

Fatigue (0-10 cm)

4.5 (2.9)

6.0 (2.9)

5.5 (3.0)

6.1 (2.9)

<0.0001

CDAI*

24.1 (13.1)

30.9 (13.6)

28.1 (15.2)

30.2 (15.3)

<0.0001

DAS28**

4.8 (1.4)

5.4 (1.3)

5.2 (1.5)

5.5 (1.4)

<0.0001

HAQ-DI (0-3)

0.8 (0.6)

1.2 (0.7)

1.1 (0.7)

1.3 (0.8)

<0.0001

RAPID3 (0-10)

4.3 (2.3)

5.6 (2.2)

4.9 (2.4)

5.5 (2.5)

<0.0001

RADAI Joint Area (0-48)

11.0 (8.0)

15.3 (9.7)

13.3 (9.7)

15.6 (9.6)

<0.0001

Erosions

148 (21%)

107 (25%)

80 (20%)

34 (21%)

0.466

ESR (mm/h)

24.7 (19.9)

28.4 (21.8)

29.7 (25.1)

35.8 (28.5)

<0.0001

CRP (mg/dl)

11.5 (15.7)

15.5 (19.0)

16.5 (18.2)

22.6 (24.8)

<0.0001

RF+

410 (65%)

270 (67%)

195 (56%)

96 (64%)

0.006

Anti-CCP+

323 (63%)

172 (61%)

147 (52%)

68 (58%)

0.018

MTX baseline

462 (66%)

301 (69%)

290 (74%)

136 (83%)

<0.0001

MTX dose 0 months

19.6 (4.1)

20.4 (4.3)

18.7 (4.4)

19.1 (4.2)

<0.0001

MTX 3 months

496 (71%)

328 (75%)

312 (80%)

137 (84%)

0.001

MTX dose 3 months

20.4 (4.0)

21.2 (4.1)

19.8 (4.4)

20.9 (3.6)

0<0.0001

Biologics (0 or 3 months)

34 (5%)

18 (4%)

18 (5%)

11 (7%)

0.618

*CDAI n=X, N=Y, N=Z, respectively; DAS n=X, N=Y, N=Z

 

 

Table 2: Change in selected outcomes over time.

 

Month

 

0

3

6

12

18

CDAI (n)

1631

1513

1321

1398

1122

  None

24.1 (13.1)*

13.6 (11.6)

10.0 (10.0)

7.9 (8.7)

7.5 (9.2)

  Oral

28.1 (15.2)

14.6 (12.4)

11.8 (11.0)

8.9 (9.6)

8.8 (9.8)

  IA

30.9 (13.6)

13.9 (11.0)

12.4 (11.8)

9.5 (10.1)

8.8 (10.1)

  Both

30.2 (15.3)

17.7 (14.0)*

14.4 (13.4)*

11.8 (11.8)*

9.7 (9.5)

DAS28 (n)

1532

1279

1147

1209

973

  None

4.8 (1.4)*

3.5 (1.4)

3.0 (1.4)*

2.8 (1.3)

2.7 (1.4)

  Oral

5.2 (1.5)

3.6 (1.5)

3.3 (1.5)

3.0 (1.4)

3.0 (1.5)

  IA

5.4 (1.3)

3.6 (1.4)

3.4 (1.5)

3.0 (1.5)

2.9 (1.4)

  Both

5.5 (1.4)

4.2 (1.6)*

3.7 (1.5)*

3.3 (1.5)*

3.1 (1.4)

RAPID3 (n)

1662

1563

1370

1453

1190

  None

4.3 (2.3)*

2.7 (2.1)*

2.3 (2.1)*

2.1 (2.0)*

2.1 (2.0)

  Oral

4.9 (2.4)*

3.1 (2.3)

2.9 (2.2)

2.6 (2.2)

2.8 (2.4)

  IA

5.6 (2.2)

3.1 (2.2)

2.8 (2.3)

2.6 (2.2)

2.5 (2.3)

  Both

5.5 (2.5)

3.8 (2.4)*

3.5 (2.4)*

3.1 (2.4)*

3.1 (2.4)

MD Global (n)

1603

1485

1325

1410

1114

  None

45.4 (24.7)*

25.3 (22.5)

17.4 (19.4)*

14.9 (19.3)

13.3 (18.8)

  Oral

50.6 (24.4)

27.7 (24.1)

22.6 (22.9)

15.3 (19.6)

14.3 (19.7)

  IA

54.8 (23.0)

25.8 (21.8)

21.4 (21.8)

15.2 (19.5)

14.6 (19.4)

  Both

52.9 (25.2)

30.8 (25.4)

24.2 (23.2)

17.2 (20.9)

14.3 (19.4)

Biologics (n)

1689

1689

1689

1689

1689

  None

23 (3%)

34 (5%)

46 (7%)

61 (9%)

72 (10%)

  Oral

9 (2%)

17 (4%)

35 (9%)

53 (14%)

59 (15%)

  IA

6 (1%)

18 (4%)

28 (6%)

54 (12%)

62 (14%)

  Both

5 (3%)

10 (6%)

27 (16%)

40 (24%)

35 (21%)

*Statistically different from any other group based on Duncan multiple comparison (p<0.05)

 

 

 

 

 

 

Disclosure: K. Andersen, None; D. Lin, None; S. J. Bartlett, PCORI, 2,NIH, 9; G. Boire, None; B. Haraoui, Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 2,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 5,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 8; C. Hitchon, Health Sciences Centre Foundation, 2; S. Jamal, None; E. C. Keystone, Janssen Inc., 2,Abbott/AbbVie, 5,Amgen, 2,Bristol-Myers Squibb, 5,Janssen Inc., 5,Hoffmann-La Roche, Inc., 5,Janssen Inc., 2,Janssen Inc., 5,Merck Pharmaceuticals, 5,Merck Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5; J. E. Pope, None; D. Tin, None; J. C. Thorne, Amgen, Canada, 5; V. Bykerk, None.

To cite this abstract in AMA style:

Andersen K, Lin D, Bartlett SJ, Boire G, Haraoui B, Hitchon C, Jamal S, Keystone EC, Pope JE, Tin D, Thorne JC, Bykerk V. Characteristics and Outcomes Associated with Early Corticosteroid Use in a Large Multicenter Canadian RA Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/characteristics-and-outcomes-associated-with-early-corticosteroid-use-in-a-large-multicenter-canadian-ra-cohort/. Accessed .

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