Short-term dose and duration-dependent glucocorticoid risk for cardiovascular events in glucocorticoid-naive patients with rheumatoid arthritis
Short-term dose and duration-dependent glucocorticoid risk for cardiovascular events in glucocorticoid-naive patients with rheumatoid arthritis
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DOI：
10.1136/annrheumdis-2021-220577
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发表时间：
2021-12-01
影响因子：
27.4
通讯作者：
Kremer, Joel M.
中科院分区：
文献类型：
--
作者：
Ocon, Anthony James;Reed, George;Kremer, Joel M.
目的类风湿性关节炎（RA）与糖皮质激素的使用沿着，与心血管疾病密切相关。糖皮质激素治疗类风湿关节炎的心血管安全性存在争议，可能与剂量和使用时间有关。我们确定，如果启动糖皮质激素激素类风湿关节炎患者会增加心血管事件（CVE）的风险，在短期intervention.Methods的剂量和持续时间依赖性的方式参加CorEvitas（原Corrona）RA注册。考克斯比例风险模型估计了开始糖皮质激素治疗的患者中发生CVE的校正HR（aHR），校正了RA病程、传统心血管风险因素和随时间变化的协变量：临床疾病活动指数、疾病缓解抗风湿药物使用和泼尼松等效使用。结果19902例患者均符合标准，其中19902例患者的糖皮质激素使用情况包括当前日剂量、累积剂量和使用时间。发生1106例CVE（1.66/100人年）。在当前剂量>= 5- 9 mg 1.56（1.18-2.06）和>= 10 mg 1.91（1.31-2.79）时，aHR增加，而在0- 4 mg 1.04（0.55-1.59）时风险未增加。在过去6个月的累积剂量显示，在751- 1100 mg 1.43（1.04-1.98）和> 1100 mg 2.05（1.42-2.94）时，aHR增加，在较低剂量时没有增加风险;在过去6个月的使用持续时间显示，使用1.54（1.08-2.32）> 81天的aHR增加，在较短的持续时间内没有增加风险。一年的分析是consistent.Conclusions在过去的6个月和1年的时间间隔，开始糖皮质激素类风湿关节炎患者与CVE的风险增加，每日剂量>= 5毫克，增加累积剂量和使用时间。每日强的松的剂量与CVE的风险无关，
Objectives Rheumatoid arthritis (RA), along with glucocorticoid use, is associated with cardiovascular disease. Cardiovascular safety of glucocorticoids in RA is controversial and may be related to dose and duration of use. We determined if initiating glucocorticoids in steroid-naive RA patients would increase cardiovascular event (CVE) risk in a dose and duration-dependent manner over short-term intervals.Methods Patients enrolled in CorEvitas (formerly Corrona) RA registry. Cox proportional-hazards models estimated adjusted HRs (aHR) for incident CVE in patients who initiated glucocorticoid treatment, adjusting for RA duration, traditional cardiovascular risk factors and time-varying covariates: Clinical Disease activity Index, disease-modifying antirheumatic drugs use and prednisone-equivalent use. Glucocorticoid use assessed current daily dose, cumulative dose and duration of use over rolling intervals of preceding 6months and 1year.Results 19902 patients met criteria. 1106 CVE occurred (1.66/100 person-years). Increased aHR occurred at current doses of >= 5-9mg 1.56 (1.18-2.06) and >= 10mg 1.91 (1.31-2.79), without increased risk at 0-4mg 1.04 (0.55-1.59). Cumulative dose over preceding 6months showed increased aHR at 751-1100mg 1.43 (1.04-1.98) and >1100mg 2.05 (1.42-2.94), without increased risk at lower doses; duration of use over preceding 6months exhibited increased aHR for >81days of use 1.54 (1.08-2.32), without increased risk at shorter durations. One-year analyses were consistent.Conclusions Over preceding 6-month and 1-year intervals, initiating glucocorticoids in steroid-naive RA patients is associated with increased risk of CVE at daily doses >= 5mg and increased cumulative dose and duration of use. No association with risk for CVE was found with daily prednisone of