Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists

Abstract

Introduction/AimsGlucocorticoids (GC) are first‐line therapy for many neuromuscular diseases. There is a lack of guidelines regarding the prevention and management of GC complications in the context of neuromuscular disease, introducing the potential for practice variation, that may compromise quality of care. Our aim was to evaluate the practice patterns among Canadian adult neuromuscular neurologists on the screening, management, and treatment of GC‐related complications and to identify variances in practice.MethodsA web‐based anonymous questionnaire was disseminated to 99 Canadian adult neuromuscular neurologists. Questions addressed patterns of screening, prevention, monitoring, and treatment of GC‐induced adverse events, including infection prophylaxis, vaccination, bone health, hyperglycemia, and other complications.ResultsSeventy‐one percent completed the survey. Of those, 52% perform screening blood work prior to initiating GC, 56% screen for infections, and 18% for osteoporosis. The majority monitor glycemic control and blood pressure (>85%). Thirty‐two (46%) reported that they do not primarily monitor GC complications, but rather provide recommendations to the primary care physician. Pneumocystis jiroveci pneumonia prophylaxis was never used by 29%, and 29% recommend vaccinations prior to GC initiation. Calcium supplementation was recommended by 80% to prevent osteoporosis. Only 36% were aware of any existing guidelines for preventing GC complications, and 91% endorsed a need for neurology‐specific guidelines.DiscussionThere is substantial variability in the management of GC adverse effects among neuromuscular neurologists, often not corresponding to limited published literature. Our results support the need for improved education and neurology‐specific guidelines to help standardize practice and improve and prevent complications.

Would glucocorticoids be approved for clinical use if discovered today?

“…9 The study by Stepanian et al in this issue highlights practice patterns of chronic GC management in practice. 10 A questionnaire with 17 questions was e-mailed to 99 adult neuromuscular neurologists in Canada. The survey assessed their practice regarding screening for co-morbidities or risk for AEs prior to commencing GC, monitoring for AEs or complications during treatment with GC and prophylaxis or treatment of AEs due to GC.…”

“…Vaccinations were only recommended by a third of the physicians. 10 The major finding of this survey was the practice variation across all three domains: screening prior to starting GC, monitoring for AEs and instituting prophylaxis against preventable complications. The cross-cutting areas such as GC treatment is an important part of education.…”

“…Although neurologists reported monitoring complications in about a quarter of the patients, the mechanisms for managing these AEs remains unclear. 10 Long-term use of GC is more prevalent in some subspecialties of neurology such as neuromuscular diseases and autoimmune neurology.…”