Prednisone Use and Risk of Mortality in Patients With Rheumatoid Arthritis: Moderation by Use of Disease-Modifying...

Area of Science:

• Rheumatology
• Clinical Pharmacology
• Epidemiology

Background:

• Rheumatoid arthritis (RA) medications can impact patient survival.
• Previous studies on RA medication and mortality often have short follow-up periods and do not adequately address treatment selection bias.

Purpose of the Study:

• To investigate the association between prednisone use and mortality in RA patients.
• To determine if the risk of prednisone-associated mortality is modified by concurrent use of disease-modifying antirheumatic drugs (DMARDs).

Main Methods:

• A prospective study analyzed 5,626 RA patients over up to 25 years.
• Propensity scores for prednisone and DMARD use were generated using random forests, controlling for confounding factors.
• Multivariate Cox models, incorporating propensity scores, estimated mortality risks.

Main Results:

• Prednisone use was linked to a significantly higher risk of death (HR 2.83).
• Concomitant methotrexate (MTX) use attenuated the mortality risk associated with prednisone (HR 0.99).
• Combination therapy weakened the protective effect of MTX on survival, with similar findings for sulfasalazine.

Conclusions:

• Prednisone use is associated with increased mortality in RA patients.
• Concurrent DMARD use, such as MTX, mitigates the heightened mortality risk from prednisone.
• Combined therapy may diminish the survival benefits previously associated with specific DMARDs like MTX.