Glucocorticoid trajectories over 2 years in patients with rheumatoid arthritis in a real-life setting - Imagerie Moléculaire et Stratégies Théranostiques
Article Dans Une Revue RMD Open Année : 2023

Glucocorticoid trajectories over 2 years in patients with rheumatoid arthritis in a real-life setting

Alycia Delteil
  • Fonction : Auteur
Celine Lambert
  • Fonction : Auteur
Bruno Pereira
  • Fonction : Auteur
Sandrine Malochet-Guinamand
  • Fonction : Auteur
Marie Eva Pickering
  • Fonction : Auteur
Marc Villedon
  • Fonction : Auteur
Sylvain Mathieu
Martin Soubrier
Anne Tournadre

Résumé

Objectives To analyse glucocorticoid (GC) use and trajectories in a real-life cohort of rheumatoid arthritis (RA). Methods Patients with RA included in the longitudinal RCVRIC cohort for initiating or changing biological disease-modifying antirheumatic drugs, were compared for the use of GCs at baseline. Among the GC users, the GC dose was analysed over 2 years of follow-up by group-based trajectory models. Characteristics and outcomes were compared between the trajectories. Results Among the 184 patients (RA duration 4.2 years (1.3; 12.6), Disease Activity Scores (DAS)28-C reactive protein (CRP) 4.24±2.14), 81 (44%) were on GCs. The GC users were significantly older, had higher CRP and Health Assessment Questionnaire (HAQ), more hypertension and lower lumbar T-score, but similar activity and erosive scores. Among the GC users, two trajectories were identified: trajectory 1 (n=20, 25%) with GC discontinuation in the first year and trajectory 2 (n=61, 75%) with maintenance of low-dose GCs at 2 years. Trajectory 2 was significantly associated with higher HAQ, a longer GC duration and a less frequent methotrexate association. After adjustment for HAQ, GC duration and MTX use, good EULAR responses were less frequent at 6 months and 1 year in the GC maintenance trajectory (38.3% vs 81.3%, p=0.03; 42.0% vs 82.4%, p=0.02). Diabetes, fractures and increased body mass index were noted in trajectory 2. Conclusion GCs were used in almost half of patients with established RA in real-world practice. For the majority of GC users, a long-term low dose of GCs is maintained over 2 years. These results highlight the difficulties with stopping GCs, the lack of consensus for the efficacy–safety balance of GCs, and the need to individualise the best GC tapering.

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Cancer
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Dates et versions

hal-04297864 , version 1 (21-03-2024)

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Alycia Delteil, Celine Lambert, Bruno Pereira, Marion Couderc, Sandrine Malochet-Guinamand, et al.. Glucocorticoid trajectories over 2 years in patients with rheumatoid arthritis in a real-life setting. RMD Open, 2023, 9 (4), pp.e003366. ⟨10.1136/rmdopen-2023-003366⟩. ⟨hal-04297864⟩
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