Even Low dose of steroids increase adverse effects in RA

In this observational study of U.S. claims data from 84,000 RA patients, researchers examined the relation between cumulative OGC dose during a 1-year baseline period and risk for potential OCG-related adverse events (AEs) and associated health care costs during the subsequent year.Potential OGC-related AE (osteoporosis, fracture, aseptic necrosis of the bone, type 2 diabetes, ulcer/gastrointestinal bleeding, cataract, hospitalization for opportunistic infection, myocardial infarction, or stroke) and AE-related expenditures (2013 US$) were gathered during the evaluation period. Multivariable regression models were fitted to estimate OR of AE and incremental costs for patients with AE.

In the study in total 48% of patients used OGC, and 26% experienced potentially OGC-related AEs. Compared with no steroid exposure, a cumulative OGC dose >1800 mg (average daily prednisone-equivalent dose, 10 mg) was associated with greater likelihood of any AE (25% vs. 33%; adjusted odds ratio, 1.2) and an additional average cost per patient of US$3,528. Even cumulative annual prednisone-equivalent doses of 800 mg to 1800 mg were associated with excess risks for several AEs (i.e., osteoporosis, fractures, and opportunistic infections).

The researchers concluded that Chronic exposure to low to medium doses of OGC was associated with significantly increased risk of potential OGC-related AE in patients with RA, and greater cumulative OGC dose was associated with substantially higher AE-related healthcare expenditures among patients with AE.

The study infers that even fairly low OGC doses aren't necessarily benign ,therefore clinicians generally should maintain the lowest OGC dose for the shortest period, recognizing that, in some cases, low-dose steroids might enable RA patients to avoid other medications that have their own potential toxicities.

Best JH et al. Association between glucocorticoid exposure and healthcare expenditures for potential glucocorticoid-related adverse events in patients with rheumatoid arthritis. J Rheumatol 2018 Mar; 45:320. (https://doi.org/10.3899/jrheum.170418)