Glucocorticoids Raise Risk of Infection, Even at Low Doses

Glucocorticoids increase the risk for infection, even at doses as low as 5 mg or less per day, according to an observational cohort study published in Annals of Internal Medicine.

Glucocorticoids are effective for the treatment of RA when added to disease-modifying antirheumatic drugs (DMARDs).

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‘Patients receiving higher dose of glucocorticoids are at twice the risk of serious infection compared to patients not receiving glucocorticoids.’
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The goal is short-term use, yet up to 60 percent of patients with RA remain on long-term glucocorticoids, especially at low doses. While the risk for infection at high doses is well-established, the risk with low-dose glucocorticoid therapy is less clear.

Researchers from the University of Pennsylvania used claims data to study more than 200,000 patients with RA who had been receiving stable DMARDs, including biologics, for the preceding 6 months and then compared them to patients not receiving glucocorticoids.

The study population included an older, Medicare population and a younger, generally healthier, mostly commercially insured population. They found that patients receiving higher dose glucocorticoids (>10 mg/day) had more than twice the risk of serious infection as patients not receiving glucocorticoids, although few patients were on these doses.

Even patients on the lowest dose had about a 30 percent increase in the risk of infection. According to the study authors, glucocorticoids may continue to be an important part of treatment for many patients, especially if other treatments are not fully controlling their RA, but these findings should help physicians better understand their potential risk.

Source-Eurekalert