POS0644 USE OF PARENTERAL COMPARED TO ORAL GLUCOCORTICOIDS IN EARLY RHEUMATOID ARTHRITIS IS SUPERIOR FOR CHANCE OF BEING OFF STEROIDS AND ESCALATION OF THERAPY AT 1 YEAR

Background: The 2023 EULAR recommendations for the management of Rheumatoid Arthritis (RA) emphasizes the importance of limiting the dose and duration of glucocorticoids (GC) used in early disease. However, no recommendation about the preferred route of GC administration is available, nor is it known if GC route is associated with total GC exposure [1]. Objectives: To describe the route of GC administration patients with early RA (ERA), and determine if GC route is associated with the likelihood of being GC-free and/or requiring advanced therapy at 12 months. Methods: Participants included newly diagnosed RA patients (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between (dates) and excluded if they reported GC use 90 days prior to baseline, were on advanced therapy by 3 months, or had <12 months. Patients were stratified by use of GC during the first 3 months of follow-up: none; oral only; parenteral only (intramuscular or intraarticular); or both (oral +parenteral). Multivariate logistic regression adjusted by confounders was used to calculate the OR of GC use at 6 and 12 months and/or progression to advanced therapies (biologics or JAKi). Results: The sample included 2,222 ERA patients. Mean (SD) age was 55 (15), disease duration 5.5 (3) months, 73% were female, and 86% were white, 69% were initially on methotrexate (MTX) at a mean dose of 20.1 (4.2) mg/week. Mean CDAI at baseline and 12-month scores were 26 (14) and 7.5 (8.6). The majority (1,661; 75%) received no GC; oral-only GC was 421 (19%); parenteral-only GC was 121 (5%), and both oral and parenteral was 19 (1%). Mean CDAI at baseline was lowest in the no GC and highest in those receiving both (24.1 vs 31.6, vs 30.2, vs 32.8, p<0.0001), but no differences were observed among groups at 12 months. GC and advanced therapeutics at 12 months were: 8% and 7% (no GC); 47% and 14% (oral); 26% and 14% (parenteral); 63% and 16% (both). Table 1 shows that any GC use, particularly oral-only, increases odds of chronic GC use at 6 and 12 months, as well as advanced therapy utilization. Figure 1 features a Sankey diagram illustrating changes in GC use over 12 months. Conclusion: Initial use of GC is low despite EULAR recommendations suggesting their use for patients with higher baseline disease activity. Among patients with active early RA, those receiving parenteral GC were half as likely to remain on GC at 12 months, compared to those using oral GC. Both GC groups had similar rates of use of advanced treatment use, which were higher compared to the no GC group. Parenteral GC use may support earlier discontinuation of steroids. REFERENCES: [1] Smolen JS, et al. Annals of the Rheumatic Diseases 2023;82:3-18. Figure 1Trajectory of steroid use by type (None, Oral only, Parenteral only and Both) Over the first year of follow-up. Table 1Multivariate logistic regression for GC use and advanced therapy use over time.GC use at 6 and 12 monthsVariable6 months12 monthsOR95% CIOR95% CISteroid use in the first 3 monthsOral vs None15.50(11.62, 20.69)9.82(7.33, 13.14)Parenteral vs None3.60(2.29, 5.67)4.13(2.61, 6.54)Both vs None19.79(7.25, 54.04)17.8(6.69, 47.38)Advanced therapy use by 6 and 12 monthsSteroid use in the first 3 monthsOral vs None2.15(1.23, 3.74)2.21(1.50, 3.24)Parenteral vs None1.57(0.60, 4.13)2.17(1.19, 3.95)Both vs None6.62(1.72, 25.50)2.77(0.75, 10.27)Baseline CDAI (change of 1 unit)1.03(1.01, 1.04)1.03(1.01, 1.04)Baseline MTX use (user vs non-users)3.12(1.47, 6.61)2.29(1.48, 3.55) Acknowledgements: NIL . Disclosure of Interests: Andreu Fernández-Codina Actelion, Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Mallinckrodt, Sanofi, Vifor pharma, Marie-France Valois: None declared, Susan J. Bartlett Janssen, Sandoz, Nordic, Mishquatul Wahed: None declared, Hugues Allard-Chamard AstraZeneca, Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Hoffmann-La Roche, Fresenius Kabi, GSK, Janssen Novartis, Mantra Pharma, Otsuka, Pfizer, Sandoz, Sobi, AstraZeneca, Abbvie, Amgen, Astrazeneca, BMS, Celltrion, Eli Lilly, GSK, Hoffmann-La Roche, Janssen, Novartis, Otsuka, Sandoz, Pfizer, Sobi, AstraZeneca, Eli Lilly, Fresenius Kabi, Pfizer, Louis Bessette Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Lilly, Novartis, Sanofi, TEVA, Fresenius Kabi, Sandoz, JAMP Pharma, Organon, Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Celgene, Lilly, Novartis, Sanofi, TEVA, Fresenius Kabi, Sandoz, Organon, Sobi, Amgen, BMS, Janssen, UCB, Abbvie, Pfizer, Celgene, Sanofi, Lilly, Novartis, AstraZeneca, JAMP Pharma, Glen Hazlewood: None declared, Carol A Hitchon Sandoz, Fresenius-Kabi, Pfizer, Astra Zeneca, Bindee Kuriya Abbvie, Pfizer, Pfizer, Abbvie, UCB, Pfizer, Abbvie, BMS, Sanofi, Carter Thorne Medexus, Accord, AbbVie, Acccord, Biogen, Medexus, Nordic, Organon, Jamp, JAMP, Pfizer, Vivian Bykerk Organon, Pfizer, Abbvie, Janssen, E.R. Squibb & Sons, L.L.C, BMS, Janet Pope AbbVie, Astra Zeneca, BI, BMS, Fresenius Kabi, GSK, Janssen, Lilly, Merck, Novartis, Pfizer, Sandoz, Sanofi, UCB, AbbVie, Amgen, Astra Zeneca, BI, BMS, Celltrion, Emerald, Fresenius Kabi, GSK, Janssen, Lilly, Mallinckrodt Pharmaceuticals, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sandoz, Samsung, Sanofi, Sobi, Teva, Viatris, AbbVie, BMS, Fresenius Kabi, Pfizer, Seagen, Mallinckrodt Pharmaceuticals. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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