Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Rheumatoid arthritis (RA) is a chronic inflammatory, systemic autoimmune disease that causes several health problems, such as pain, joint destruction and loss of function. Thanks to the quick anti-inflammatory effects of the Glucocorticoids (Gc), Gc are the most common remedy used for the patients who suffer from RA. The present study aims to elucidate the effects of corticosteroid usage before the initiation of biologic disease-modifying antirheumatic drugs (DMARDs) to inform clinicians regarding the proper use of the required medications.
TReasure is a multicenter, web-based registry of RA where the information concerning spondyloarthritis patients who receive the targeted treatments could be found. As of May 2018, in the context of the present study, 1,209 RA patients were recorded. Age, sex, smoking habits, disease duration, BMI, initial bDMARDs, acute phase reactants, swollen and tender joint counts (28 joints), patient global assessment of disease activity, pain VAS, DAS-28, CDAI, and SDAI were recorded before patients started to use bDMARDs. In this study, corticosteroid doses were classified as follows: low as < 2.5, medium as 2.5 to 7.5 and high as ≥7.5 mg/day.
1,209 RA patients in the TReasure database used steroid therapy (Table 1). 420 (34.7%) of the patients discontinued steroid treatment after 90±84.62 months (30-120) of follow-up. No statistically significant difference was found in the initial clinical characteristics of the patients who used or did not use Gc were evaluated (except the patients who were older or who had a lower ESR). The mean age of the patient who took Gc was 55 (45-62), RF positivity was 71.8%, CCP positivity was 64.9% and disease duration was nine years. Initially, low dose corticosteroids was used in 3.7%, medium dose corticosteroids in 61.7% and high dose in 34.6% of the patients. On the final treatment, low dose corticosteroids were used in 11.3%, medium dose corticosteroids in 64.3% and high dose in 24.4% of the patients (Figure 1, Table 2).
In the biologic registry, the administration of the Gc was stopped approximately in 35% of the patients. When the doses of the steroids usage were scrutinized, patients who received biologic DMARDs used fewer steroid dose. In 1/3 of the patients, Gc treatment was initiated with above 7.5 mg. In approximately 20% of the patients, the dose was reduced to 2.5 mg. However, 60% of the patients were using 2.5-7.5 mg Gc. Gc is frequently used as a bridge therapy because of its quick anti-inflammatory effects until the effects of DMARDs occur. However, it is notable that the corticosteroid usage was associated with more comorbidities before the initiation of biologic DMARDs among patients with RA. Our findings suggest that low and moderate doses of steroids are preferred more.
To cite this abstract in AMA style:Yagız B, Coşkun BN, Kiraz S, Ertenli I, Kucuksahin O, Dalkiliç E, Bes C, Alpay Kanitez N, Kasifoglu T, Emmungil H, Atagunduz P, Koca SS, Cinar M, Ateş A, Akar S, Gercik O, Ersozlu Bakirli D, Yazisiz V, Kimyon G, Yasar Bilge NS, Aydin Tufan M, Mercan R, Oz B, Akar ZA, Karadag O, Kelesoglu B, Yılmaz S, Turan S, Pehlivan Y, Terzioglu E, Kilic L, Erten S, Tascilar K, Kalyoncu U. Corticosteroid Utilization before and after Initiation of Biologic Dmards between Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/corticosteroid-utilization-before-and-after-initiation-of-biologic-dmards-between-patients-with-rheumatoid-arthritis/. Accessed August 1, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/corticosteroid-utilization-before-and-after-initiation-of-biologic-dmards-between-patients-with-rheumatoid-arthritis/