Background/Purpose:

Oral glucocorticoids (GCs) are commonly used in the treatment of rheumatoid arthritis (RA). Although GPs don’t typically alter DMARD prescriptions, changes to GC therapy are commonly made in primary care. It is important to assess how GCs are used in this setting, including variability in dose and duration of treatment, so that rheumatologists understand how their patients are being treated.  The objective of this study was to describe the patterns of GC prescribing for patients with RA in primary care.

Methods:

Patients with incident RA were identified from the Clinical Practice Research Datalink, a large UK general practice database.  For patients who received GCs, the mean, minimum and maximum prednisolone equivalent doses were calculated. To determine the population distribution, the median of these values across all treated patients was then calculated. A GC course was defined as back-to-back GC prescriptions where the end date of the first prescription was not more than one calendar day different from the start date of the next prescription. The median number of courses per year was then determined. The proportion of patients to receive greater than 5mg, 10mg, 20mg, 30mg, 50mg and 75mg per day was determined as was the proportion of total time on GCs these doses were prescribed for.

Results:

Of the 16 536 patients with incident RA, 7749 patients (47%) received at least one GC prescription during the follow up period. The mean duration of follow up was 4.8 years per patient. In GC users, the median proportion of time spent on GCs was 24.3% (IQR 36.2%-64.2%). Of those receiving GCs, the population distribution was a median of 7.5mg per day (IQR 5-15.7mg) for the mean dose, 5mg per day (IQR 2.5-7.5mg) for the minimum dose and 15mg per day (IQR 7.5-30mg) for the maximum dose.

Of those that received GCs, the median number of courses per year was 1.4 (IQR 0.4-3.0) and 39.4% received more than 2 GC courses per year. The median duration of each GC course was 46 days (IQR 28-81).

Of those that were prescribed GCs during follow up, 79.9% received a prednisolone equivalent daily dose of more than 5mg per day and 56.2% received more than 10mg per day. 38.2% received more than 20mg per day, 17.3% received more than 30mg per day, 3.5% received more than 50mg per day and 1.4% received more than 75mg per day. The median proportion of total time on GCs that patients received these doses is shown in the table below.

Conclusion: Half the patients with incident RA were prescribed GCs in primary care. They received GCs for 25% of the time they were observed. Of those who received GCs, 80% received doses greater than 5mg per day and 40% more than 20mg/day. Patients spent 60% of their total duration on GCs taking doses greater than 5mg per day. The extent of GC prescribing for RA patients in primary care may be surprising to many rheumatologists and highlights the need to be aware of GC use in this setting in order to avoid excess exposure and associated side effects.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/oral-glucocorticoid-prescribing-patterns-in-uk-primary-care-for-patients-with-rheumatoid-arthritis/