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A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort

OBJECTIVE: To describe patterns of glucocorticoid use in a large real‐world cohort with early rheumatoid arthritis (RA) and assess the impact on disease activity and treatment. METHODS: Data are from adults with new RA (≤1 year) recruited to the Canadian Early Arthritis Cohort (CATCH) and are strati...

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Autores principales: Andersen, Kathleen M., Schieir, Orit, Valois, Marie‐France, Bartlett, Susan J., Bessette, Louis, Boire, Gilles, Haraoui, Boulos, Hazlewood, Glen, Hitchon, Carol, Keystone, Edward C., Pope, Janet, Tin, Diane, Throne, J Carter, Bykerk, Vivian P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754017/
https://www.ncbi.nlm.nih.gov/pubmed/34708574
http://dx.doi.org/10.1002/acr2.11334
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author Andersen, Kathleen M.
Schieir, Orit
Valois, Marie‐France
Bartlett, Susan J.
Bessette, Louis
Boire, Gilles
Haraoui, Boulos
Hazlewood, Glen
Hitchon, Carol
Keystone, Edward C.
Pope, Janet
Tin, Diane
Throne, J Carter
Bykerk, Vivian P.
author_facet Andersen, Kathleen M.
Schieir, Orit
Valois, Marie‐France
Bartlett, Susan J.
Bessette, Louis
Boire, Gilles
Haraoui, Boulos
Hazlewood, Glen
Hitchon, Carol
Keystone, Edward C.
Pope, Janet
Tin, Diane
Throne, J Carter
Bykerk, Vivian P.
author_sort Andersen, Kathleen M.
collection PubMed
description OBJECTIVE: To describe patterns of glucocorticoid use in a large real‐world cohort with early rheumatoid arthritis (RA) and assess the impact on disease activity and treatment. METHODS: Data are from adults with new RA (≤1 year) recruited to the Canadian Early Arthritis Cohort (CATCH) and are stratified on the basis of whether a person was prescribed oral glucocorticoids within 3 months of study entry. Disease activity was compared over 24 months. Mixed‐effects logistic regression was used for adjusted odds ratios (aORs) of escalation to biologics separately for 12 and 24 months, with random effects terms to account for prescribing patterns clustering by study site. RESULTS: Among 1891 persons, 30% received oral steroids. Users were older, were less often employed, and had shorter disease duration and higher disease activity. Disease activity improved over time, with early glucocorticoid users starting at higher levels of disease activity. Participants with early oral glucocorticoids were more likely to be on a biologic at 12 months (aOR = 2.4; 95% confidence interval [CI], 1.5‐3.7) and 24 months (aOR = 1.9; 95% CI, 1.3‐3.0). Despite Canadian clinical practice guidelines to limit corticosteroid use to short‐term or ‘bridge’ therapy, 30% of patients who used oral glucocorticoids still used them 2 years later. CONCLUSION: Early steroids were prescribed sparingly in CATCH and were often indicative of more active baseline disease as well as the need for progression to biologics.
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spelling pubmed-87540172022-01-19 A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort Andersen, Kathleen M. Schieir, Orit Valois, Marie‐France Bartlett, Susan J. Bessette, Louis Boire, Gilles Haraoui, Boulos Hazlewood, Glen Hitchon, Carol Keystone, Edward C. Pope, Janet Tin, Diane Throne, J Carter Bykerk, Vivian P. ACR Open Rheumatol Original Articles OBJECTIVE: To describe patterns of glucocorticoid use in a large real‐world cohort with early rheumatoid arthritis (RA) and assess the impact on disease activity and treatment. METHODS: Data are from adults with new RA (≤1 year) recruited to the Canadian Early Arthritis Cohort (CATCH) and are stratified on the basis of whether a person was prescribed oral glucocorticoids within 3 months of study entry. Disease activity was compared over 24 months. Mixed‐effects logistic regression was used for adjusted odds ratios (aORs) of escalation to biologics separately for 12 and 24 months, with random effects terms to account for prescribing patterns clustering by study site. RESULTS: Among 1891 persons, 30% received oral steroids. Users were older, were less often employed, and had shorter disease duration and higher disease activity. Disease activity improved over time, with early glucocorticoid users starting at higher levels of disease activity. Participants with early oral glucocorticoids were more likely to be on a biologic at 12 months (aOR = 2.4; 95% confidence interval [CI], 1.5‐3.7) and 24 months (aOR = 1.9; 95% CI, 1.3‐3.0). Despite Canadian clinical practice guidelines to limit corticosteroid use to short‐term or ‘bridge’ therapy, 30% of patients who used oral glucocorticoids still used them 2 years later. CONCLUSION: Early steroids were prescribed sparingly in CATCH and were often indicative of more active baseline disease as well as the need for progression to biologics. John Wiley and Sons Inc. 2021-10-28 /pmc/articles/PMC8754017/ /pubmed/34708574 http://dx.doi.org/10.1002/acr2.11334 Text en © 2021 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Andersen, Kathleen M.
Schieir, Orit
Valois, Marie‐France
Bartlett, Susan J.
Bessette, Louis
Boire, Gilles
Haraoui, Boulos
Hazlewood, Glen
Hitchon, Carol
Keystone, Edward C.
Pope, Janet
Tin, Diane
Throne, J Carter
Bykerk, Vivian P.
A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title_full A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title_fullStr A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title_full_unstemmed A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title_short A Bridge Too Far? Real‐World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort
title_sort bridge too far? real‐world practice patterns of early glucocorticoid use in the canadian early arthritis cohort
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754017/
https://www.ncbi.nlm.nih.gov/pubmed/34708574
http://dx.doi.org/10.1002/acr2.11334
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