Glucocorticoid discontinuation in patients with rheumatoid arthritis who initiated biologic or targeted synthetic agents: a real-world population-based analysis.

Background

This study aimed to evaluate glucocorticoids (GCs) discontinuation after the initiation of biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in rheumatoid arthritis (RA) patients, using data from a real-world population-based registry.

Methods

We analyzed data from RA patients who initiated their first biologics or Janus kinase inhibitors (JAKi) during the period of 2006-2021. bDMARDs included anti-tumor necrosis factor (anti-TNF), anti-interleukin6 (anti-IL6), anti-CD20, and Cytotoxic T lymphocyte-associated antigen-4-Ig (CTLA4-Ig). Patients who were concurrently on GCs at the initiation of bDMARD or JAKi therapy were included. Logistic regression models were used to calculate the odds ratios (ORs) of GC discontinuation at 3 and 6 months, adjusting for potential confounders.

Results

Out of 2865 RA patients on b/tsDMARDs, 1421 patients (49.6%) (median age: 57.0 [48.0-65.0] years; female: 1162 [81.8%]; median disease duration: 2.0 [1.0-5.0] years) were on additional GC therapy initially. The overall 3-month and 6-month GC discontinuation rates were 26.2% and 36.8%, respectively. At month 3, after adjusting for age, prior chronic GC use, current csDMARDs use and hypertension, anti-TNF (OR 0.520, 95% CI: 0.383-0.707) and anti-CD20 (OR 0.134, 95% CI: 0.057-0.278) treatments were significantly associated with a lower likelihood of GC discontinuation compared to JAKi therapy. At month 6, after adjusting for age, prior chronic GC use and hypertension, anti-TNF therapy (OR 0.560, 95% CI 0.412-0.761), anti-CD20 therapy (OR 0.461, 95% CI 0.274-0.764), and CTLA4-Ig (OR 0.492, 95% CI 0.254-0.919) were independently associated with a reduced likelihood of GC discontinuation compared to JAKi therapy. No statistically significant difference was observed between JAKi and anti-IL6 therapy at either time point.

Conclusions

In the real-world setting, a high prevalence of RA patients was on GCs at the time of the initiation of b/tsDMARDs. However, only a limited proportion of these patients were able to discontinue GCs by months 3 and 6. Initiation of JAKi therapy was associated with a greater likelihood of glucocorticoid discontinuation compared with selected bDMARDs, while no statistically significant difference was observed relative to anti-IL6 therapy.