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Glucocorticoid Benefits Outweighed Adverse Effects Among Patients With Rheumatic Conditions
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Although patients who received glucocorticoids as treatment for rheumatic conditions reported considerable adverse effects, the majority felt the benefits of therapy offset the harms, according to patient survey data published in the Journal of Clinical Rheumatology.
Rachel J. Black, MBBS, of the University of Adelaide, in Australia, and colleagues also concluded that the adverse effects that posed the greatest life impact were also often difficult for physicians to measure.
“This study was important as it is a step towards the development of a tool that measures the benefits and harms of glucocorticoids from the patient perspective,” Black told Healio Rheumatology. “It is well recognized that the patient's experience of a treatment is an important indicator of quality.”
To analyze the beneficial and adverse effects of glucocorticoids in those with rheumatic diseases from the patient’s perspective, with the purpose of developing a patient-reported outcome measure, the researchers conducted a cross-sectional survey of two groups. The first cohort consisted of 55 patients attending a tertiary rheumatology clinic, with various diseases, who had used glucocorticoids within the past year. The other cohort was made up of patients on the rheumatoid arthritis database from the Hospital for Special Surgery, in New York, which included 95 glucocorticoid users and 29 nonusers.
According to the researchers, 100% of glucocorticoid users in the tertiary rheumatology clinic, and 86% of glucocorticoid users in the Hospital for Special Surgery database, reported at least one adverse effect. The prevalence of adverse effects per person was 50% higher in the clinic cohort compared with glucocorticoid users in the hospital group (7.7 vs. 5.3; adverse event ratio: 1.5; 95% CI, 1.3–1.7), and 2-fold greater in the hospital cohort among glucocorticoid users compared with nonusers (5.3 vs. 2.6; adverse event ratio: 2; 95% CI, 1.6–2.6).
In addition, the worst adverse effects identified in both cohorts by glucocorticoid users included skin thinning/easy bruising, sleep disturbance, mood disturbance and change in facial shape. According to the researchers, 78% of patients in the clinic cohort, and 62% in the hospital cohort, felt glucocorticoids helped their disease a lot. Meanwhile, 55% of patients in the clinic group, and 64% in the hospital group, felt that the benefits were greater than the adverse effects. Many adverse effects were more frequent in glucocorticoid users than in nonusers, according to the researchers.
“Many of the glucocorticoid adverse effects that are important to patients are not easily measured in the clinic setting such as thin skin/easy bruising, sleep disturbance and change in face shape, supporting the need for a patient-reported outcome measure,” Black said. “The patient-perceived efficacy of glucocorticoids in the treatment of rheumatic conditions was also reinforced by the finding that the benefits of treatment outweighed the adverse effects for the majority of respondents.”
According to Black, the results will inform the development of a patient-reported outcome measure to capture the effects of glucocorticoids from the patient's perspective.
“These finding support the need for a patient reported outcome measure for the benefits and adverse effects of glucocorticoid use,” he said. “In conjunction with other survey-based and qualitative research, they will contribute to the development of such a tool.” – by Jason Laday
Disclosure: The researchers report funding from the Weill Cornell Clinical Translational Science Center. Black reports funding from an Australian Postgraduate Award and an Arthritis South Australia/Australian Rheumatology Association postgraduate grant.
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