Clinician and Patient Factors Associated With Long-Term Glucocorticoid Use in People With Rheumatoid Arthritis...

Despite guideline recommendations, long-term glucocorticoid (GC) use is common in rheumatoid arthritis (RA). We conducted a clinician survey nested within a large registry to identify patient and clinician factors associated with GC use.

Clinicians contributing patients to the CorEvitas Rheumatoid Arthritis Registry were surveyed between 2023 and 2024, capturing demographics, medication safety concerns, and a range of other attitudes. We then identified patients with RA initiating a new biologic or JAK inhibitor (JAKi). Patient factors associated with GC use six months after treatment initiation were assessed with a mixed-effects logistic regression model. Similar models assessed clinician factors associated with GC use at six months, adjusting for patient factors.

Among 256 active clinicians, 92 (36%) responded to the survey, of which 81 had 3,966 qualifying patients, whereas 164 nonresponders had 3,196 qualifying patients. Higher disease activity, age ≤45 or >75 years, longer disease duration, more previous biologics/JAKi, lung disease, and earlier calendar year were associated with greater GC use at six months. Clinicians with less concern about prednisone ≤5 mg/day were more likely to prescribe GCs at six months (adjusted odds ratio [aOR] 1.98, confidence interval [CI] 1.17-3.36), but similar or stronger associations were seen for clinicians with less concern about biologics (aOR 2.47, 95% CI 1.33-4.49) or JAKi (aOR 2.35, 95% CI 1.31-4.22).

Lower clinician concerns about GC, biologic, and JAKi safety were associated with greater GC prescribing, suggesting that broad attitudes toward prioritizing treatment benefits versus risks (rather than just specific GC concerns) may drive GC prescribing, with important implications for clinician education.