Prednisone linked to increased risk of pneumonia

Rheumatoid arthritis patients taking the commonly prescribed steroid, prednisone, run a significantly higher risk of contracting pneumonia than do those on biologic medications, according to research presented at the American College of Rheumatology’s  Annual Scientific Meeting.

But biologic drugs, such as adalimumab (HUMIRAT), etanercept (Enbrel) and infliximab (Remicade), aren’t without their own risks. The drugs, which copy the effects of substances naturally made by the body’s immune system, have been associated with increased rates of infection during clinical trials.

To compare the risks of biologic therapy with prednisone use, researchers conducted a two-and-a-half-year study of responses to questionnaires from 15,966 long-term arthritis patients, whose average age was 60.5 years. Participants who used biologic drugs were 30% more likely to get pneumonia; those on prednisone were 170% more likely. Therefore prednisone, the corticosteroid most often prescribed to treat inflammation, poses a much larger risk, researchers concluded.

Between 35% and 45% of patients with rheumatoid arthritis currently use prednisone, but more than 70% of patients will take the steroid at one time during their lifetime. Although researchers noted that the patient’s functional status as well as the severity of his or her condition plays a role in predicting infection, the study’s results demonstrate that much larger attention should be paid to steroid therapy.

“The risk associated with prednisone use ... is substantial and suggests that, rather than being considered a relatively benign therapy, prednisone is likely a large part of the risk associated with pneumonia,” stated Frederick Wolfe, MD, National Data Bank for Rheumatic Diseases, an investigator in the study.

SOURCE: “Prednisone May Be a High Risk Factor for Pneumonia in Rheumatoid Arthritis Patients,” The American College of Rheumatology, Oct. 15, 2004.