Half of UK patients with rheumatoid arthritis are prescribed oral glucocorticoid therapy in primary care: a retrospective drug utilisation study

Rachel J. Black, Rebecca M. Joseph, Benjamin Brown, Mohammad Movahedi, Mark Lunt, William G. Dixon

Patients with rheumatoid arthritis (RA) have shared care between rheumatologists and general practitioners (GPs). Rheumatologists guide immunosuppressive therapy, whilst GPs rely on analgesia and glucocorticoid (GC) therapy to manage active disease. The objective of this study was to describe patterns of GC prescribing for patients with RA in primary care and to determine the influence of patient characteristics and prescriber. Incident RA patients were identified within the Clinical Practice Research Datalink, a United Kingdom (UK) primary care research database. Descriptive statistics identified patterns of oral GC prescribing. Prescribers were categorised by their tendency to prescribe GCs (high/low). Logistic regression was used to identify baseline characteristics associated with GC prescriptions during follow-up and to examine whether baseline characteristics influenced prescribing differently in high versus low prescribers. A total of 7777 patients (47 %) received ≥1 GC prescription during follow-up. The average daily dose was 7.5 mg (IQR 5-15.3 mg). Of those who received GCs, >50 % were prescribed >10 mg/day and 20 % >30 mg/day. The median proportion of time spent on GCs was 26.3 % (IQR 3.8-70.0 %). Age and cardiovascular disease (CVD) were associated with increased likelihood of receiving GCs. High prescribers more commonly prescribed GC therapy in older patients and patients with hypertension. Half of patients with incident RA received GCs in primary care. Average GC use was 7.5 mg for 25 % of the time, perhaps higher usage than rheumatologists and GPs might expect. GCs were prescribed more commonly in certain high-risk populations, including older patients and those with CVD.