Ocon AJ, Reed G, Pappas DA, et al. - Over preceding 6-month and 1-year intervals, starting glucocorticoids in steroid-naïve rheumatoid arthritis (RA) patients was shown to be linked with elevated risk of cardiovascular event (CVE) at daily doses ≥5 mg and increased cumulative dose and duration of use. Daily prednisone of ≤4 mg or shorter cumulative doses and durations were not related to the risk for CVE.

• Patients enrolled in CorEvitas (formerly Corrona) RA registry were analyzed to ascertain whether commencing glucocorticoids in steroid-naive RA patients would elevate CVE risk in a dose and duration-dependent manner over short-term intervals.

• Criteria for inclusion were satisfied by 19,902 patients, and occurrence of 1,106 CVE (1.66/100 person-years) was reported.

• At current doses of ≥5–9 mg and ≥10 mg, increased adjusted HRs (aHR) were obtained 1.56 (1.18–2.06) and 1.91 (1.31–2.79), respectively, without elevated risk at 0–4 mg 1.04 (0.55–1.59).

• Over preceding 6 months, cumulative dose demonstrated elevated aHR at 751–1,100 mg 1.43 (1.04–1.98) and >1,100 mg 2.05 (1.42–2.94), without elevated risk at lower doses; span of use over preceding 6 months showed increased aHR for >81 days of use 1.54 (1.08–2.32), without elevated risk at shorter spans.

• It was noted that 1-year analyses were consistent.