Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis

Abstract

Abstract:Objectives:To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and the GC-sparing ability of other therapies. Methods:Nineteen experts on glucocorticoid use and outcome measures from 11 subspecialties participated. Ten experts were from the United States; 9 from Canada, Europe, or Australia.Group consensus methods and multi-criteria decision analysis (MCDA) were utilized.A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists. Results:Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List.Composite GTI evaluation showed high inter-rater agreement (investigators kappa 0.88, external raters kappa 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgment, participants ranked 15 cases by clinical judgment in order of highest to lowest GC toxicity. Expert rankings were then compared to case ranking by the Composite GTI,

Statin-induced anti-HMGCR myopathy: successful therapeutic strategies for corticosteroid-free remission in 55 patients

“…Taken altogether, these results suggest that in anti-HMGCR myopathy, achieving a serum CK level ≤ 500 UI/L could define remission and be the goal of both successful induction and maintenance strategies. Targeting early remission may be justified to minimize steroid therapy [21]. Indeed, IVIG use in the 3 months after presentation of necrotizing myopathy was associated with better outcomes at 6 months [10].…”

“…In parallel, a corticosteroid-based induction strategy composed of corticosteroids, IVIG, and a steroidsparing immunosuppressant (SSI) was proposed as the initial treatment of severe anti-HMGCR myopathy [10]. Since this disease occurs in older patients who often have diabetes mellitus [19] and cardiovascular disease, corticosteroid-free induction and maintenance strategies are of utmost interest to minimize treatment-related morbidity [20,21].…”

Emerging Use of Early Health Technology Assessment in Medical Product Development: A Scoping Review of the Literature

“…Therefore, alternative methods to measure value have been explored and used such as discrete-choice experiments and MCDA and it is quite easy to see how such preference elicitation models could be used to estimate the relative value of (hypothetical) new technologies [56], or how they can be used to support R&D teams making decisions based on relative values of the alternative technologies [57]. …”

Why have hospitalization rates for bullous pemphigoid soared?

“…We are in need of safer and more specific therapies to manage patients with BP, who are predominantly elderly individuals already with comorbidities . Future studies comparing new treatments for BP with oral corticosteroids could compare the complications over time using the Glucocorticoid Toxicity Index rather than just mortality …”

“…5,6 Future studies comparing new treatments for BP with oral corticosteroids could compare the complications over time using the Glucocorticoid Toxicity Index rather than just mortality. 11,12…”