Prednisone Raises Mortality Risk in Rheumatoid Arthritis

Treatment with prednisone in patients with rheumatoid arthritis (RA) was associated with significantly increased risk of mortality, according to a recent study.

While glucocorticoids have been used in the treatment of RA for decades, they can potentially cause serious adverse events. Because prednisone is commonly used in patients with severe RA, the full extent of the drug’s effect on mortality is unclear.
_______________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Could Oral Prednisone Improve Sciatica Outcomes?
Rheumatoid Arthritis Drugs Linked to Serious Infection
_______________________________________________________________________________________________________________________________________________________________________

In order to better define the relationship between prednisone use and mortality, researchers conducted a prospective study of 5626 patients with RA (mean age 57 years), of which 62% had been treated with prednisone, 52% with methotrexate, and 14% with sulfasalazine. Among participants, median disease duration at enrollment was 7.1 years, median duration of prednisone exposure was 2 years, and median dose of prednisone was 5 mg/day.

Over the course of the study, 666 patients (11.8%) died. In a multivariate, propensity-adjusted model, prednisone use was associated with increased risk of death (HR 2.83 [95% CI 1.03, 7.76]), but, when combined with methotrexate, the risk was attenuated (HR 0.99 [95% CI 0.18, 5.36]).

Researchers noted that while combination of prednisone and methotrexate reduced the risk of death associated with prednisone use, it also weakened the protective effects of methotrexate.

“Prednisone use was associated with a significantly increased risk of mortality in patients with RA. This association was mitigated by concomitant disease-modifying antirheumatic drug use, but combined treatment also negated the previously reported beneficial association of methotrexate with survival in RA,” they concluded.

 —Michael Potts

Wasko MC, Dasgupta A, Sears GI, et al. Prednisone use and risk of mortality in patients with rheumatoid arthritis: Moderation by use of disease-modifying anti-rheumatic drugs. Arthritis Care and Research. October 1, 2015 [epub ahead of print]. DOI: 10.1002/acr.22722.