Glucocorticoids Linked to Higher Mortality Rates in Patients with RA and Diabetes

Sarfaroj Khan 

Disclosures

March 05, 2021

Takeaway

  • Glucocorticoid (GC) use was associated with higher mortality rates in patients with rheumatoid arthritis (RA) and concomitant type 2 diabetes (T2D) vs patients with RA who did not have T2D, despite apparently reassuring similar relative risks.

Why this matters

  • Rheumatologists should consider diabetes status while prescribing GCs to patients with RA given the potential impact of GC therapy on glucose control and mortality.

Study design

  • This retrospective study included 9085 patients with RA (mean follow-up, 5.2 years) using data from the Clinical Practice Research Datalink (CPRD) which was linked to mortality data from the Office of National Statistics.

  • Event rates for all-cause mortality and cardiovascular mortality were compared by GC use status and T2D status.

  • Funding: Centre for Epidemiology Versus Arthritis and the NIHR Biomedical Research Centre.

Key results

  • In patients with RA and T2D, the mortality rate was higher with GC exposure vs no exposure (67.4/1000 person-years [pyrs]; 95% CI, 57.1-79.5 vs 22.5/1000 pyrs; 95% CI, 18.7-27.1).

  • Similarly, the mortality rate was higher in patients with RA who did not have T2D (GC exposure: 44.6/1000 pyrs; 95% CI, 40.6-48.9 and no GC exposure: 10.2/1000 pyrs; 95% CI, 9.1-11.4).

  • The risk ratio (RR) of GC use on all-cause mortality was slightly lower in patients with RA and T2D vs those with RA alone (RR, 2.99; 95% CI, 2.32-3.87 vs 4.37; 95% CI, 3.77-5.07).

  • Despite this lower RR, those with T2D had a higher rate difference vs those with no T2D (rate difference, 44.9 deaths/1000 pyrs; 95% CI, 32.9-56.8 vs 34.4 deaths/1000 pyrs; 95% CI, 30.1-38.7).

  • A similar pattern was seen for cardiovascular mortality.

Limitations

  • Retrospective design.

  • Risk of misclassification.

 

Costello RE, Marsden A, Movahedi M, Lunt M, Humphreys JH, Emsley R, Dixon WG. The effect of glucocorticoid therapy on mortality in patients with rheumatoid arthritis and concomitant type II diabetes: a retrospective cohort study. BMC Rheumatol. 2020;4(1):4. doi: 10.1186/s41927-019-0105-4. PMID: 33648598. View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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