More Adverse Events and Higher Costs for Patients With RA on High-Dose Glucocorticoids

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Although glucocorticoids are frequently used in rheumatoid arthritis, there is lack of consensus on the appropriate dose and duration of treatment.
Although glucocorticoids are frequently used in rheumatoid arthritis, there is lack of consensus on the appropriate dose and duration of treatment.

Chronic exposure to high doses of oral glucocorticoids (OGC) is associated with significantly increased risk for adverse events and substantially higher related healthcare expenditures for patients with rheumatoid arthritis (RA), according to a study recently published in The Journal of Rheumatology.

Data for this large, real-world, claims-based study came from the Medicare Supplemental Databases and Truven Health MarketScan Commercial Claims, reflecting the healthcare experiences of retired patients whose employers pay for supplemental insurance as well as those of privately insured individuals. 

The patients included in the data sample experienced at least 2 nondiagnostic claims related to RA from January 1, 2012, to December 31, 2012, and were at least 18 years old (average age range 57.0 years to 59.7 years).

The final number of patients included in the study sample was 84,357, divided into groups according to OGC dose: 0 mg (52.4%), between 0 and 300 mg (13.6%), between 300 and 800 mg (10.5%), between 800 and 1800 mg (13.1%), and >1800 mg (10.4%).

The study consisted of a 12-month baseline phase and a 12-month evaluation phase. Data analysis showed an association between a greater cumulative dose of OGC and an elevated risk for OGC-related adverse events (cataract, type 2 diabetes, fracture, osteoporosis, aseptic necrosis of the bone, myocardial infarction, ulcer/gastrointestinal bleeding, hospitalization for opportunistic infection, and/or stroke), primarily at cumulative OGC doses >1800 mg over 12 months. For patients with no OGC exposure, average adverse events-related healthcare cost was $6079. Average adverse events-related healthcare cost for patients with chronic exposure to high dose OGC (>1800 mg cumulative exposure) was $12,311. Even after adjustment, incremental costs were still $3528 higher for patients taking >1800 mg.

This is the first observational study that used real-world data to determine the risk and cost for potential OGC-related adverse events for patients with RA. The findings showed that patients are at greater risk for OGC-related adverse events in the year following 12 months of treatment with a high cumulative dose of OGC and risk incurring substantially higher incremental costs related to these adverse events.

Study investigators conclude, “Given that uncertainty remains about the appropriate use of OGC among patients with RA, these results suggest that all efforts (such as earlier implementation of steroid-sparing treatment) should be made to avoid high dose and chronic OGC therapy.”

Reference

Best JH, Kong AM, Lenhart GM, Sarsour K, Stott-Miller M, Hwang Y. Association between glucocorticoid exposure and healthcare expenditures for potential glucocorticoid-related adverse events in patients with rheumatoid arthritis. J Rheumatol. 2018;45(3):320-328.

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