Session Type: Abstract Submissions (ACR)
Glucocorticoid (GC) therapy is widely used in patients with rheumatoid arthritis (RA). Its association with incident type II diabetes mellitus (DM) is accepted, but the extent of the risk and its relationship with GC dose and treatment duration in RA are not known.
Adult patients with RA were identified from a large UK primary care research database using a validated algorithm during the study period 1992-2009. Patients with prevalent DM at the time of their first code for RA were excluded. GC exposure was identified from oral GC prescriptions and was analysed using multivariable time-dependent Cox models with conventional exposure measures (eg on/off treatment) and a novel weighted cumulative dose (WCD) model that accounted for past doses and treatment duration and timing. Incident DM was defined as a READ code for type II DM, at least two oral anti-diabetic prescriptions or abnormal blood results (blood sugar, HbA1C or glucose tolerance test). Hazard ratios (HR) associated with different GC patterns were adjusted for gender, age, family history of DM, hypertension, prior cumulative dose of oral GC, current DMARDs and ever NSAID use.
22,535 adult RA patients were included. 70% were female with a median age of 60 years (IQR 49-71). Median follow-up time per patient was 5.4 years. 2,324 patients were diagnosed with type II DM during follow-up: incidence 13.7 events/1000 person years (pyrs) in unexposed patients versus 21.8 events/1000pyrs after GC exposure. Ignoring dose and duration, the conventional HR was 1.42 (1.30-1.56) in ever GC users compared with non-users. This equates to one additional case of DM per year for every 172 patients who received GCs at some time in the past. The WCD model showed risk increased with increased dose and duration of recent use, especially in the past 8 months. 5mg prednisolone equivalent (PEQ) for past 1, 3 and 6 months were associated with HRs of 1.14, 1.36 and 1.46, respectively, compared to non-use. Doses more than eight months ago added little to the current risk of DM, e.g. increasing the duration of 5mg PEQ exposure from the past 6 to 12 months increased the HR to only 1.49 compared to non-use. Risk increased significantly with dose: 30mg PEQ for 1, 3 or 6 months generated HRs of 2.2, 6.3 and 9.8, respectively, compared to non-use. 5mg or 30mg PEQ for 6 months equates to one additional case for every 140 or 7 patients treated, respectively.
Oral GC therapy is a clinically important and quantifiable risk factor for incident Type II DM in patients with RA, influenced by dose and duration of exposure within the last eight months.
W. G. Dixon,
M. E. Beauchamp,
D. W. Ray,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quantifying-the-risk-of-incident-type-ii-diabetes-following-oral-glucocorticoid-therapy-in-patients-with-rheumatoid-arthritis-association-with-dose-and-duration-of-use/