Patterns of steroid use in patients with established rheumatoid arthritis commencing treatment with biologic or...

To investigate the clinical use of steroids in established RA.

A cohort of RA patients commencing treatment with biologic or targeted synthetic (b/ts) DMARDs was followed prospectively, with clinical data recorded pre-baseline and at the 3, 6 and 12-month follow-up. Patients were included in this analysis if they had completed the first year of follow-up and had data on steroid use available for at least one follow-up. The proportions of patients receiving steroids at different timepoints were compared and further differentiated between continued (receiving steroids at two consecutive timepoints) and newly started treatment. Lastly, mixed linear effect models were used to assess the relationship between clinical factors and steroid use.

The cohort (N = 1846) had a median disease duration of 7 years and, across each timepoint, ≈30% of patients received steroids, up to two-thirds of which continued treatment from a preceding follow-up. At 12 months, the proportion of patients continuing treatment decreased, but more patients started steroid treatment (P < 0.001). Linear mixed effects modelling further showed that steroid use was more common in patients who had required pre-baseline steroids [odds ratio (OR) 1.44 (95% CI 1.38, 1.49)] and in those on later-stage treatments [OR 1.15 (95% CI 1.08, 1.23)].

Despite the introduction of b/tsDMARDs, steroid use in this cohort continued over the first year of follow-up, particularly in patients with more severe RA. Together with previous data, this further highlights the need for future research and trials to better understand the right course of steroid administration to maximize efficacy and limit adverse side effects.