Glucocorticoids linked to higher mortality rates in RA, comorbid diabetes
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Glucocorticoid use was associated with higher rates of mortality among patients with rheumatoid arthritis and concomitant type 2 diabetes, compared with those without diabetes, according to data published in BMC Rheumatology.
“Although GCs have many benefits, they also have risks associated with them, including possible increased risk of CV events and mortality,” Ruth E. Costello, MSc, BSc, of the University of Manchester, in the United Kingdom, and colleagues wrote. “In addition, GCs are known to increase the risk of diabetes mellitus (DM) and are associated with poor glucose control, meaning they may also affect the long-term outcome of DM (including CV events and mortality). This has not been investigated in patients with RA.”
“Further, it is not known how the additional burden of DM and then GC therapy influence the cardiovascular and mortality risk in patients with RA,” they added. “Therefore, an important unanswered question is whether GC treatment in RA is associated with worse outcomes in patients with comorbid DM, compared to patients without DM.”
To analyze the relationship between glucocorticoids, diabetes and mortality among patients with RA, Costello and colleagues conducted a retrospective cohort study of primary care electronic medical records in the United Kingdom. The researchers identified 9,085 adults with RA who were registered at their practice for at least 1 year prior to diagnosis, and who had linked data in both the Clinical Practice Research Datalink and the Office of National Statistics.
Using these databases, Costello and colleagues identified glucocorticoid use through prescription information, and type 2 diabetes through read codes, prescriptions and blood tests. They calculated mortality rate ratios and rate differences (RD) across different exposure groups and used Cox proportional hazards regression models to calculate interaction on the multiplicative and additive scales.
According to the researchers, glucocorticoid use in patients without comorbid diabetes resulted in a 4.4-fold increased all-cause mortality risk ratio (95% CI, 3.83-5.14), compared with non-use. Further, patients with comorbid diabetes demonstrated a lower risk ratio for glucocorticoid use (3.02; 95% CI 2.34-3.9). However, patients with diabetes had a higher rate difference associated with glucocorticoid use due to a higher baseline risk.
Among patients with diabetes, glucocorticoid use was associated with an additional 46.7 deaths per 1,000 person-years (95% CI, 34.1-59.3) compared with non-use.
For those without diabetes, glucocorticoid use was associated with an additional 36.2 deaths per 1,000 person-years (95% CI, 31.6-40.8). Researchers wrote they saw a similar pattern for cardiovascular mortality. The adjusted Cox proportional hazards model demonstrated no evidence for multiplicative interaction. However, additive interaction indicated a non-significant increased risk. Meanwhile, there was no interaction on either scale for cardiovascular mortality.
“This study gives an indication that GC therapy may be associated with a higher number of deaths in patients with RA and comorbid type 2 DM,” Costello and colleagues wrote. “Rheumatologists should consider DM status when prescribing GCs to patients with RA given this potential impact of GC therapy on glucose control and mortality.” – by Jason Laday
Disclosures: Costello reports no relevant financial disclosures. Co-author William G. Dixon, MRCP, PhD, of the University of Manchester, reports consulting fees from Bayer and Google.
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