Evaluating the impact of long-term glucocorticoid use on cancer risk in patients with rheumatologic diseases: A retrospective cohort study.

Abstract

10532 Background: Long-term glucocorticoid (GC) therapy is widely used in the management of rheumatologic diseases, but its immunosuppressive effects have raised concerns about a potential increased risk of cancer. The association between long-term steroid use in patients with rheumatologic diseases and the development of cancer remains unclear. This study aims to evaluate cancer prevalence in patients with rheumatologic conditions who are on long-term steroids compared to those who are not. Methods: A retrospective cohort study was conducted involving 35,272 patients with rheumatologic diseases between 2011 and 2024. Patients with rheumatoid diseases were categorized into two groups: those receiving long-term GC therapy (≥30 days; n=5521) and those not on GC therapy (n= 29,751). Cancer prevalence was assessed in both groups as well as their subgroups based on sex, and age. Prevalence rates and odds ratios (OR) were calculated to determine the association between steroid use and cancer. Results: Cancer prevalence was significantly higher among GC users (34.2%) compared to non-GC users (20.8%). The odds ratio for cancer in GC users was 1.97 (95% CI: 1.95–2.02), indicating 97% increased odds of cancer for GC users. Stratified by sex, female GC users had a cancer prevalence of 32.6%, compared to 19.9% in non-GC users, with an odds ratio of 1.96 (95% CI: 1.48–2.59), suggesting a nearly two-fold increase in cancer risk. In male patients, cancer prevalence in GC users was 38.2%, compared to 23.4% in non-GC users, with an odds ratio of 2.02 (95% CI: 1.72–2.41), indicating a 102% increase in cancer risk. In those aged over 18 years, cancer prevalence in GC users was 34.5%, compared to 21.3% in non-GC users, with an odds ratio of 1.94 (95% CI: 1.75–2.14), suggesting a significantly higher cancer risk for those on long-term steroid therapy. Conclusions: Long-term steroid use in patients with rheumatologic diseases is associated with a higher prevalence of cancer. This association was observed across both sexes and age groups. The substantial cancer risk observed in patients without a personal history of cancer underscores the need for cautious GC prescribing and regular cancer screening. Further investigations should focus on additional factors, including race and comorbidities, to better understand the modulating factors behind this association and refine clinical decision-making.