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  • Lauper, KimCentre for Epidemiology Versus Arthritis,Geneva University Hospital (author)

Oral glucocorticoid use in patients with rheumatoid arthritis initiating TNF-inhibitors, tocilizumab or abatacept : Results from the international TOCERRA and PANABA observational collaborative studies

  • Article/chapterEnglish2024

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  • 2024

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  • LIBRIS-ID:oai:lup.lub.lu.se:49fd0a3f-d2c4-4465-80bf-91ccf9bb9b7c
  • https://lup.lub.lu.se/record/49fd0a3f-d2c4-4465-80bf-91ccf9bb9b7cURI
  • https://doi.org/10.1016/j.jbspin.2023.105671DOI

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  • Language:English
  • Summary in:English

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  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • Objective: To evaluate and compare the use of oral glucocorticoids with three classes of bDMARDs in patients with rheumatoid arthritis (RA). Methods: We included patients from 13 observational registries treated with a TNF-inhibitor, abatacept or tocilizumab and with available information on the use of oral glucocorticoids. The main outcome was oral glucocorticoid withdrawal. A McNemar test was used to analyse the change in the use of glucocorticoids after 1 year. Kaplan-Meier estimates and Cox regressions, adjusted for patient, treatment, and disease characteristics, were used to evaluate glucocorticoid discontinuation in patients with glucocorticoids at baseline. Because of heterogeneity, analyses were done by registers and pooled using random-effects meta-analysis. Results: A total of 12,334 participants treated with TNF-inhibitors, 2100 with tocilizumab and 3229 with abatacept were included. At one-year, oral glucocorticoid use decreased in all treatment groups (odds ratio for stopping vs. starting of 2.19 [95% CI 1.58; 3.04] for TNF-inhibitors, 2.46 [1.39; 4.35] for tocilizumab; 1.73 [1.25; 2.21] for abatacept). Median time to glucocorticoid withdrawal was ≈2 years or more in most countries, with a gradual decrease over time. Compared to TNF-inhibitors, crude hazard ratios of glucocorticoid discontinuation were 0.65[0.48–0.87] for abatacept, and 1.04 [0.76–1.43] for tocilizumab, and adjusted hazard ratios were 1.1 [0.83–1.47] for abatacept, and 1.30 [0.96–1.78] for tocilizumab. Conclusion: After initiation of a bDMARD, glucocorticoid use decreased similarly in all treatment groups. However, glucocorticoid withdrawal was much slower than advocated by current international guidelines. More effort should be devoted to glucocorticoid tapering when low disease activity is achieved.

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  • Mongin, DenisGeneva University Hospital (author)
  • Bergstra, Sytske AnneLeiden University Medical Centre (author)
  • Choquette, DenisUniversity Of Quebec In Montreal (author)
  • Codreanu, CatalinCarol Davila University of Medicine and Pharmacy (author)
  • Gottenberg, Jacques EricUniversity Hospital Of Strasbourg (author)
  • Kubo, SatoshiUniversity of Occupational and Environmental Health, Japan (author)
  • Hetland, Merete LundUniversity of Copenhagen,Copenhagen University Hospital (author)
  • Iannone, FlorenzoUniversity of Bari Aldo Moro (author)
  • Kristianslund, Eirik K.Diakonhjemmet Hospital (author)
  • Kvien, Tore K.Diakonhjemmet Hospital (author)
  • Lukina, GalinaV.A. Nasonova Research Institute of Rheumatology (author)
  • Mariette, XavierCenter For Immunology Of Viral Infections And Autoimmune Diseases (author)
  • Nordström, Dan C.National Register for Biologic Treatment in Finland (ROB-FIN),Helsinki University Central Hospital (author)
  • Pavelka, KarelInstitute of Rheumatology, Prague (author)
  • Pombo-Suarez, ManuelCIBER de Fisiopatología Obesidad y Nutricion (CIBEROBN) (author)
  • Rotar, ZigaUniversity Medical Centre Ljubljana (author)
  • Santos, Maria J.Hospital Garcia de Orta (author)
  • Tanaka, YoshiyaUniversity of Occupational and Environmental Health, Japan (author)
  • Turesson, CarlLund University,Lunds universitet,Reumatologi,Forskargrupper vid Lunds universitet,Rheumatology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-ctn (author)
  • Courvoisier, Delphine S.Geneva University Hospital (author)
  • Finckh, AxelGeneva University Hospital (author)
  • Gabay, CemGeneva University Hospital (author)
  • Centre for Epidemiology Versus ArthritisGeneva University Hospital (creator_code:org_t)

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