Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Glucocorticoid (GC) therapy is known to increase the risk of new-onset type 2 diabetes mellitus (DM). Furthermore, GC therapy increases blood glucose in diabetic patients, thereby potentially leading to worse outcomes. This study aimed to examine the impact of GC use on all-cause and cardiovascular (CV) mortality in patients with RA and DM, and to compare to the impact of GC use on mortality in patients with RA but no DM.
Methods
Adult patients with RA were identified from the Clinical Practice Research Datalink, a UK primary care research database. Type 2 DM was defined using READ codes, anti-diabetic treatment or abnormal blood results. GC exposure was identified from oral GC prescriptions. Mortality data, including cause of death, were obtained through linkage to the Office for National Statistics. All-cause and CV mortality rates with 95% confidence Interval (CI) were calculated for ever/ never GC use and categories of cumulative dose. Data were analysed using multivariable time-dependent Cox models to assess the association between GC and death, adjusting for potential confounders.
Results
We studied 3,397 patients with RA and DM and 17,883 patients with RA but no DM with a median follow-up of 3.6 and 5.3 years, respectively, during which 699 (266 from CVD cause) and 2,887 (1,016 from CVD cause) patients died. All-cause mortality rate was 4.6 (95% CI 4.3-5.0) and 2.7 (95% CI: 2.6-2.8) per 100 person-years (pyrs) in DM and non-DM cohorts, respectively.
In patients with RA and DM, the adjusted relative risk (aRR) and absolute risk difference (ARD) of all-cause mortality were 2.0 (95% CI: 1.6-2.4) and 4.2 per 100pyrs (95% CI: 3.5-5.0) in ever GC use compared with never GC use, respectively. There was a dose response relation between both all-cause and CV mortality, and cumulative GC dose category. Patients in the highest category of cumulative GC dose (≥7,299 mg) had an aRR of 3.4 (95%CI: 2.5-4.6) and compared to non GC users for all-cause mortality.
In patients with RA but no DM, the aRR and ARD of all-cause mortality was 2.3 (95% CI: 2.0-2.5) and 2.9 per 100pyrs (95% CI: 2.7-3.2) in ever GC use compared to never GC use, respectively. Risk of all-cause mortality was increased with increasing cumulative dose category. Similar results were observed for risk of CV mortality in association with cumulative GC dose.
Whilst the aRR for all-cause mortality was lower in patients with RA and DM compared to patients without DM (2.0 vs 2.3), the ARD was higher (4.2 vs 2.9 per 100 pyrs). The table below shows the association between GC use patterns and all-cause and CV mortality.
|
Oral GC pattern |
All cause mortality
|
|||
|
RA and DM
|
RA but no DM
|
|||
|
aRR |
ARD Per 100 pyrs |
aRR |
ARD Per 100 pyrs |
|
|
Never use Ever use
|
Ref 2.0 (1.6-2.4) |
– 4.2 (3.5-5.0) |
Ref 2.3 (2.0-2.5) |
– 2.9 (2.7-3.2) |
|
Cumulative dose category Non GC use Low (>0-959.9 mg) Med (960-3054.9 mg) High (3055-7298.9 mg) Very high (≥7299 mg)
|
Ref 1.7 (1.3-2.2) 1.8 (1.3-2.3) 2.3 (1.7-3.0) 3.4 (2.5-4.6) |
– 0.6 (-0.4-1.7) 1.6 (0.4-2.9) 3.8 (2.4-5.3) 5.4 (3.8-7.1) |
Ref 1.8 (1.6-2.1) 2.2 (1.9-2.6) 2.4 (2.1-3.8) 3.3 (2.8-3.8) |
– 0.3 (0.1-0.6) 1.7 (1.3-2.2) 2.5 (2.1-3.0) 4.5 (3.9-5.1) |
|
Oral GC pattern |
CV mortality
|
|||
|
RA and DM |
RA but no DM |
|||
|
aRR |
ARD Per 100 pyrs |
aRR |
ARD Per 100 pyrs |
|
|
Never use Ever use
|
Ref 2.0 (1.4-2.7) |
– 1.4 (0.9-1.9) |
Ref 1.8 (1.5-2.2) |
– 0.9 (0.8-1.1) |
|
Cumulative dose category Non GC use Low (>0-959.9 mg) Med (960-3054.9 mg) High (3055-7298.9 mg) Very high (≥7299 mg) |
Ref 1.7 (1.2-2.7) 1.8 (1.2-2.8) 2.3 (1.5-3.6) 2.4 (1.5-4.0) |
– 0.3 (-0.3-1.1) 0.7 (-0.1-1.5) 1.7 (0.8-2.6) 1.0 (0.1-1.9)
|
Ref 1.4 (1.2-1.9) 1.5 (1.2-2.0) 2.2 (1.7-2.8) 2.8 (2.2-3.7) |
– -0.02 (-0.2-0.2) 0.4 (0.2-0.7) 1.0 (0.7-1.3) 1.6 (1.2-1.9) |
Conclusion
Oral GC therapy is associated with higher all-cause and CV mortality in RA patients with DM, although residual confounding may explain some of the association. Whilst the aRR is slightly lower that that seen in patients with RA but no DM, the higher background mortality rate in patients with DM means this lower aRR is associated with more excess deaths.
Disclosure:
M. Movahedi,
None;
W. G. Dixon,
None.
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