Patients with rheumatoid arthritis (RA) and other chronic conditions frequently receive low-dose glucocorticoids (GCs) as bridging therapy when starting or changing disease-modifying antirheumatic drug (DMARD) treatment. However, there are concerns regarding the long-term use of GCs having the potential for clinically significant adverse events.

This retrospective cohort study examines and quantifies the risk for hospitalized infection in patients on stable DMARD therapy who received low-dose glucocorticoids over the long term. This observational study’s setting is from Medicare claims data and Optum’s deidentified Clinformatics Data Mart database from 2006 to 2015. The subjects, being adults with RA receiving a stable DMARD regimen for more than 6 months. Among 172,041 patients in Medicare 247,297 observations were identified, and 58,279 observations among 44,118 patients in Optum. 

Medicare patients not receiving GCs, compared to the exposed group was 8.6% versus

  •  11.0% (≤5 mg/d),
  •  14.4% ( >5 to 10 mg/d),
  •  17.7% (>10 mg/d).

Optum patients not receiving GCs, compared to the exposed group were 4.0% versus

  •  5.2% (≤5 mg/d),
  •  8.1% (>5 to 10 mg/d),
  •  10.6% (>10 mg/d)

In conclusion, GCs were associated with a dose-dependent increase in the risk for severe infection, with small but significant risks at doses of 5 mg or less daily. Clinicians are to balance the benefits of low-dose glucocorticoids with this potential risk.