ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 1889

Patterns of Glucocorticoid Use and Provider-Level Variation in a Commercially Insured Incident Rheumatoid Arthritis Population

Beth Wallace1,2,3, Paul Lin2,4, Neil Kamdar2,4, Mohamed Noureldin2,3,5, Rodney Hayward2,3,6, David A. Fox1, Jeffrey R. Curtis7, Kenneth Saag8 and Akbar Waljee2,3,9, 1Department of Internal Medicine, Division of Rheumatology, Michigan Medicine, Ann Arbor, MI, 2University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 3Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 4University of Michigan Medical School, Ann Arbor, MI, 5Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, 6Department of Internal Medicine, Division of General Medicine, Michigan Medicine, Ann Arbor, MI, 7University of Alabama at Birmingham, Birmingham, AL, 8University of Alabama, Birmingham, AL, 9Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: glucocorticoids, Practice, rheumatoid arthritis (RA) and treatment

  • Tweet
  • Email
  • Print
Session Information

Date: Monday, October 22, 2018

Title: 4M094 ACR/ARHP Abstract: Health Services Research I: Focus on Big Data (1887–1892)

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Glucocorticoids (GC) reduce RA-related disability and joint damage; RA guidelines endorse short term use during DMARD initiation and flares. Long-term high-dose GC exposure (>3 months, ≥10mg/day prednisone equivalent) can be toxic, but risk/benefit balance varies across patients. GC exposure patterns and user characteristics have not been described in a national commercially insured cohort. Provider-level factors may affect patterns of GC use in RA, and may interact with patient factors to alter risk/benefit balance. We hypothesize that GC are commonly used for incident RA and are continued inappropriately once DMARD treatment is established, and that wide provider-level variation in GC use exists.

 

Methods: Using OptumInsightTM commercial claims data, we identified 9,221 adults with incident RA diagnosed 2010-2014 and ≥12 months of preceding medical and pharmacy benefits. We assessed GC exposure for 3 months before and 12 months following diagnosis (“study period”), cumulatively and stratified by 3 month quarter and GC prescriber specialty (rheumatologist, primary care provider, other). We examined variation among 117 rheumatologists by dividing per-patient distribution of GC dose and duration for each quarter into quartiles.

Results:   6,717 RA patients (73%) received GC during the study period. There were no clinically important differences in demographics or baseline health status between GC users and non-users, or by cumulative GC exposure level. GC use rose with frequency of rheumatologist visits and number of DMARD prescriptions. 76% of patients filled a DMARD prescription in quarter 1, and 17% received a biologic DMARD by quarter 4 (Table 1).

During quarter 1, 53% of patients received GC with per-patient mean daily dose 15mg prednisone equivalent/day and duration 57 days. During quarter 4, 29% of patients received GC with per-patient mean daily dose 14mg/day and duration 48 days. Rheumatologists prescribed >60% of all dispensed GC, with mean daily dose 11-18mg and duration 30-60 days per quarter (Table 1). Per-patient dose and duration of GC prescribed vary widely at the provider level over the study period (Fig. 1).

Conclusion: In this commercially insured incident RA cohort, rheumatologists commonly prescribe long term high dose GC up to 1 year after RA diagnosis, despite appropriate DMARD and biologic use. Rheumatologist practices regarding GC use for RA vary widely. Further work is needed to evaluate the relationship between 1) specific patient and provider-level factors and GC exposure, and 2) GC exposure and DMARD initiation and persistence in this population.




Disclosure: B. Wallace, None; P. Lin, None; N. Kamdar, None; M. Noureldin, None; R. Hayward, None; D. A. Fox, None; J. R. Curtis, AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Radius, Roche/Genentech, UCB, 2, 5; K. Saag, Amgen, 2, 5,Merck & Co., 2, 5,Lilly, 5,Radius, 5; A. Waljee, None.

To cite this abstract in AMA style:

Wallace B, Lin P, Kamdar N, Noureldin M, Hayward R, Fox DA, Curtis JR, Saag K, Waljee A. Patterns of Glucocorticoid Use and Provider-Level Variation in a Commercially Insured Incident Rheumatoid Arthritis Population [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/patterns-of-glucocorticoid-use-and-provider-level-variation-in-a-commercially-insured-incident-rheumatoid-arthritis-population/. Accessed .
  • Tweet
  • Email
  • Print

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/patterns-of-glucocorticoid-use-and-provider-level-variation-in-a-commercially-insured-incident-rheumatoid-arthritis-population/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology