Black Patients Prescribed Glucocorticoids More Often

Glucocorticoids are a type of corticosteroid hormone that are used widely to lower inflammation in autoimmune and inflammatory diseases, including rheumatoid arthritis. However, these medications have a risk of many serious long-term side effects, such as high blood pressure, diabetes, and osteoporosis.

A new study presented at ACR Convergence 2020, the annual meeting of the American College of Rheumatology, found that Black patients with rheumatoid arthritis (RA) were more likely to use glucocorticoids and less likely to be prescribed a biologic treatment than white patients.

Biologics are more advanced and targeted therapies used to treat rheumatoid arthritis and other inflammatory diseases by acting on specific parts of the immune system, which lowers inflammation and prevents joint damage.

Researchers analyzed electronic health record data from 1,831 patients with rheumatoid arthritis at an academic center in Pennsylvania from 2010 to 2018. These patients had at least two rheumatoid arthritis diagnoses from an outpatient encounter, and at least one prescription of a disease-modifying antirheumatic drug (DMARD).

Of the patients in the study, 82 percent were female, 35 percent were Black, 54 percent were white, and the mean age was 55. Black patients in this study were more likely to be older, have a higher body mass index (BMI), be former or current smokers, and have higher rates of cardiovascular disease and diabetes.

The researchers found that there were racial disparities in how rheumatoid arthritis was treated between Black and white patients.

The glucocorticoid medication prednisone and conventional synthetic disease-modifying antirheumatic drug (DMARD) treatments (such as methotrexate) were used significantly more with Black patients than white patients: 79.3 percent of Black patients versus 69.1 percent of white patients used prednisone, while 96.7 percent of Black patients versus 93.5 percent of white patients used a conventional DMARD.

On the other hand, 74 percent of white patients versus 67 percent of Black patients were prescribed a biologic drug. Black patients had significantly more visits to the hospital emergency department over the span of eight years.

Previous research has also found that non-white rheumatoid arthritis patients have a lower frequency of biologic use than white patients, even when accounting for disease activity and treatment access.

“This project supports prior work showing reduced use of biologics and a greater use of prednisone in patients who were Black, which could potentially mean worse outcomes or increased steroid side effects in this group,” study coauthor, Michael George, MD, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania, said in a press release.

“A key next step that many are working on is understanding the key drivers of these disparities — understanding why they exist (e.g., access to medications, insurance, patient-provider communication, health beliefs, etc.) is important so we know how to address these disparities,” he said.

This study will add to existing literature covering racial disparities in rheumatoid arthritis care, which is key to improving the health of patients.

“With the explosion of effective therapies for rheumatoid arthritis, it is particularly important to make sure that we are treating patients in the best way possible,” said Dr. George. “Variability in practice, and disparities in treatment, suggest that there is room for significant improvement.”

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He E, et al. Characterization of Racial Disparities in Rheumatoid Arthritis Treatment Choice and Location of Care [abstract]. Arthritis & Rheumatology. November 2020.

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