title: Seven-year tolerability profile of glucocorticoids use in early rheumatoid arthritis: data from the ESPOIR cohort.
abstract: OBJECTIVE
  To explore the 7-year tolerability profile of glucocorticoids (GC) for early rheumatoid arthritis (RA).
  
  
  METHODS
  We examined data for 602 patients with RA from the early arthritis Etude et Suivi des POlyarthrites Indifférenciées Récentes (ESPOIR) cohort (<6 months disease duration) stratified into two groups: with or without GC treatment at least once during follow-up (median 7 years (IQR 0.038-7.65)). The main outcome was a composite of death, cardiovascular disease (including myocardial ischaemia, cerebrovascular accident and heart failure), severe infection and fracture.
  
  
  RESULTS
  Among the 602 patients with RA (476 women (79%), mean age 48±12 years), 386 with GC (64.1%) received low-dose prednisone (mean 3.1±2.9 mg/day for the entire follow-up): 263 started GC during the first 6 months (68%), and the mean duration of total GC treatment was 1057±876 days. As compared with patients without GC (216 (35.9%)), those with GC showed greater use of non-steroidal anti-inflammatory drugs, synthetic and biological disease-modifying antirheumatic drugs and had more active disease disability, higher C reactive protein and anticitrullinated protein antibody levels. Among 65 events (7 deaths, 14 cardiovascular diseases, 19 severe infections and 25 fractures), 44 and 21 occurred in patients with and without GC (p=0.520). Infections were more frequent, although not significantly, in patients with than without GC (p=0.09). On weighted Cox proportional-hazards analysis, with use of propensity score and inverse-probability-of-treatment weighting, and including age, gender, history of hypertension and GC treatment, outcomes did not differ with and without GC (p=0.520; HR=0.889; 95% CI 0.620 to 1.273).
  
  
  CONCLUSIONS
  This 7-year analysis of the ESPOIR cohort supports the good safety profile of very low-dose GC for early active RA.
authors.affiliation: Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.|Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Roubille
authors.affiliation: Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.|Statistiques, University Institute of Clinical Research, EA2415, Montpellier, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rincheval
authors.affiliation: Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP, Paris, France.|INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Department of Rheumatology, Roger Salengro Hospital, Lille, France.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.affiliation: Statistiques, University Institute of Clinical Research, EA2415, Montpellier, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daurès
authors.affiliation: Rheumatology Department, Lapeyronie Hospital, Montpellier University, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: Corticosteroids; Early Rheumatoid Arthritis; Outcomes research; Rheumatoid Arthritis