OBJECTIVES: Long-term use of oral glucocorticoid (OGC) therapy may be associated with adverse effects; thus, OGC-sparing approaches to treatment of rheumatoid arthritis (RA) may benefit patients. This study examined OGC use in rituximab-treated RA patients with prior exposure to anti-tumor necrosis factor-alpha (anti-TNF) therapy. METHODS: Administrative claims-based retrospective study. Study patients met the following criteria: initiated rituximab between March 1, 2006-March 31, 2011 (initiation date=index) after exposure to anti-TNF therapy, aged ≥18 years, had a medical claim with a diagnosis code for RA (ICD-9-CM 714.0x) between January 1, 2004-March 31, 2011, continuously enrolled for 12 months before and ≥90 days after index, had no medical claims with diagnosis codes for non-RA indications of biologic disease modifying antirheumatic drugs (BDMARDs) within 12 months before index. Using rituximab infusion dates and the recommended administration frequency schedule, rituximab exposure periods were constructed. Exposure periods commenced upon index and terminated at the first occurrence of switch to a different BDMARD, 90-day gap in rituximab treatment, loss to follow-up, or follow-up of 36 months. Outcomes were any OGC use and mean daily OGC dose expressed in prednisone equivalent and averaged among all patients, measured throughout the exposure period in sequential 90-day intervals. Multivariable generalized estimating equation models tested for statistically significant changes in OGC use over time. RESULTS: Study included 1,763 rituximab exposure periods (1,718 unique patients); mean age 54.9 years, 81.5% female, 54.0% with OGC use within 30 days before index. Between the first and last 90-day intervals, the probability of OGC use and the mean daily OGC dose decreased significantly: from 0.56 to 0.36 (p<0.001) and from 3.5mg/day to 2.7mg/day (primarily driven by OGC discontinuation) (p<0.001), respectively. Sensitivity analyses subset to exposure periods lasting a full 36 months yielded similar results. CONCLUSIONS: Statistically significant decreases in OGC use were observed in rituximab-treated RA patients with prior exposure to anti-TNF therapy.