Session Type: Abstract Submissions (ACR)
Oral glucocorticoids (GCs) are commonly used in the treatment of rheumatoid arthritis (RA) and GC prescriptions are often issued in the primary care setting. The objective of this study was to describe the patterns of GC prescribing for patients with RA in UK primary care and to identify patient characteristics that are associated with GC use.
16 536 patients with incident RA were identified from the Clinical Practice Research Datalink, a large UK general practice database. Descriptive statistics were used to identify patterns of GC prescribing for these patients. For patients who received more than one GC prescription over the observation period, the mean, minimum and maximum prednisolone equivalent doses were calculated. The median of these values across all treated patients was then calculated. Stepwise linear regression was used to identify baseline patient characteristics associated with GC prescriptions including: Demographics, Inflammatory comorbidities, GC-associated comorbidities and DMARDs.
7749 patients (47%) received at least one GC prescription during the follow up period. The median proportion of time spent on GCs was 24.3% (IQR 36.2%-64.2%). The median mean dose per treated patient was 7.5mg per day (IQR 5-15.7mg), the median minimum dose per treated patient was 5mg per day (IQR 2.5-7.5mg) and the median maximum dose per treated patient was 15mg per day (IQR 7.5-30mg).
Each 10-year increase in age was found to be associated with a 17% greater likelihood of being prescribed GCs (95%CI 1.14-1.20). There was no association with patient gender. Higher GC prescribing was seen in patients with inflammatory comorbidities of the lung: asthma (OR 1.59, 95%CI 1.43-1.76), chronic obstructive pulmonary disease (OR 1.65, 95%CI 1.35-2.01) and lower respiratory tract infections (OR 1.21, 95%CI 1.10-1.33). However, there was no association with inflammatory conditions of the skin or GI tract. The association with GC-associated comorbidities was less consistent. GC prescribing was higher in patients with cardiovascular disease (OR 1.27, 95%CI 1.05-1.53) and in current smokers (OR 1.22, 95%CI 1.13-1.32) but lower in patients with diabetes (OR 0.71, 95%CI 0.62-0.82) and high cholesterol (OR 0.86, 95%CI 0.76-0.97). There was no association with other GC-associated comorbidities including osteoporosis, avascular necrosis, myopathy, insomnia, depression, hypertension, peptic ulcer disease or pancreatitis. A previous GC prescription prior to RA diagnosis was the strongest predictor of ever use post-diagnosis (OR 9.38, 95%CI 8.41- 10.46). GC prescribing was lower with methotrexate (OR 0.81, 95%CI 0.66-0.98) and sulfasalazine use (OR 0.69, 95%CI 0.58-0.83), but higher with leflunomide (OR 1.76, 95%CI 1.19-2.61) and other DMARD use (OR 1.73, 95%CI 1.33-2.26).
The presence of certain comorbidities at diagnosis, in particular inflammatory lung conditions, influenced GC prescribing. GC therapy was prescribed more commonly in higher risk patients, including older patients and those with CVD. Other GC-associated comorbidities, such as diabetes and hyperlipidaemia, were associated with less GC prescribing.
R. J. Black,
W. G. Dixon,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-factors-associated-with-oral-glucocorticoid-prescribing-patterns-in-uk-primary-care-for-patients-with-rheumatoid-arthritis/