SAT0592 THE IMPACT OF ORAL GLUCOCORTICOIDS ON THE DEVELOPMENT OF CATARACTS AND GLAUCOMA IN INCIDENT RHEUMATOID ARTHRITIS PATIENTS

Background: Cataracts and glaucoma are recognised glucocorticoid (GC) adverse effects. However, the impact of GC use, dose and timing on the development of cataracts and glaucoma has not been well quantified. Objectives: 1. To determine the association between GC use and dose and the development of cataract and glaucoma in patients with incident RA, 2. To determine the lag effect of GC dose. Methods: Data were used from the Clinical Practice Research Datalink (CPRD), a large UK primary care database derived from an electronic medical record (Jan 1992- Dec 2017). RA patients were identified using a validated algorithm and only incident patients were included. Parametric log-logistic survival models were used to assess the impact of GC use, dose (prednisolone daily dose equivalent) and lagged dose (at 1, 3, 6 months, 1 & 2 years). A square root transformation of dose was used for the cataract models. Smoking, gender and uveitis were included as covariates in the model and age was used as the timescale. Comorbidities on the causal pathway, such as diabetes and hypertension, were not included. Results were reported as odds ratios (OR) for the cumulative incidence. Results: There were 22607 patients with incident RA (median age 66, IQR 37-84, 68% female), of which 241 had cataracts and 164 had glaucoma on or before baseline. Median duration of follow up was 8.7 years (IQR 1.8-19.8) and 39% were ever GC users during follow up. The incidence rate, per 1000 patient-years was 12.3 (95% CI 11.8, 12.9) for cataracts and 3.1 (95% CI 2.8, 3.4) for glaucoma, and increased with age. Uveitis was an important predictor for both cataracts and glaucoma, and cataracts were more frequent in females. GC use and GC dose were associated with both cataracts and glaucoma (Table 1). In the multivariable lagged dose analysis, GC dose at 1-year prior had the greatest effect size for cataracts (OR 1.26, 95% CI 1.12, 1.42), whereas GC dose at 3-months prior had the greatest effect size for glaucoma (OR 1.06, 95% 1.01, 1.11). Conclusion: The quantification of the risk associated with GCs and the development of cataract and glaucoma is of clinical utility in daily practice. EULAR guidelines recommend patients are informed of the risks and benefits of GC treatment prior to commencement, however the risk of these potential adverse effects had not previously been quantified. This information will allow patients to make better-informed treatment choices in conjunction with their treating doctor. Disclosure of Interests: None declared