Evaluation of the toxicity of glucocorticoids in patients with autoimmune blistering disease using the Glucocorticoid Toxicity Index: A cohort study

Abstract

Background Glucocorticoids are the mainstay of treatment for autoimmune blistering diseases (AIBDs). The Glucocorticoid Toxicity Index (GTI) is a novel, outcome-based glucocorticoid-induced adverse effects monitoring instrument. Objective To investigate whether the GTI score was able to accurately quantify the glucocorticoid-induced toxicity in patients with AIBDs. Methods The prospective cohort study included patients with confirmed diagnoses of AIBDs (group1, currently receiving glucocorticoids; and group 2, had glucocorticoids ceased earlier). Data were collected minimally at baseline (V1) and 3 months (V2). Further data from patients who were able to complete the follow-up visits at 6 months (V3) and 12 months (V4) amid the COVID-19 pandemic were also included. GTI scores were calculated after data collection. Results Analysis of data from V1 and V2 found a linear correlation between GTI score and prednisone doses ( P < .05) and a significant difference in GTI scores between group1 and group 2 ( P < .05). Data from V3 and V4 suggested that GTI scores continued to rise progressively alongside increasing cumulative prednisone dose. Limitations Small sample size, further exacerbated by the COVID-19 pandemic. Single-center study. Conclusion The GTI sensitively and specifically captured the changes in glucocorticoids toxicity over time among patients with AIBDs. The GTI could be a feasible tool that can be used in future clinical trials as a glucocorticoid-induced toxicity outcome measure.

Applicability of glucocorticoid toxicity index in pemphigus: Comparison between two groups of rituximab‐treated and rituximab‐naïve patients

“…Murrell and her team have recently evaluated the toxicity of glucocorticoids in a cohort of patients with autoimmune blistering disease using GTI. 31 To our knowledge, the present study is the first published research employing the GTI in the context of RTX therapy in pemphigus patients. Further multicentric studies evaluating GTI in pemphigus patients comparing RTX with other steroid-sparing agents like azathioprine and mycophenolate mofetil along with disease severity measurements such as Pemphigus Disease Area Index (PDAI) will be of great value.…”

“…However, experts in the design of the GTI recommended including each item when the probability of it being GC‐related was more than 5% and it was less likely to be caused by the disease itself. Murrell and her team have recently evaluated the toxicity of glucocorticoids in a cohort of patients with autoimmune blistering disease using GTI 31 . To our knowledge, the present study is the first published research employing the GTI in the context of RTX therapy in pemphigus patients.…”

Burden of pemphigus vulgaris with a particular focus on women: A review

“… 74 , 75 Finally, long-term immunosuppressive therapy with CSs may cause disturbance in psychiatric health (depression, mania, and cognitive impairment), known as the most common adverse event of steroids according to the Glucocorticoid Toxicity Index. 28 …”

“…[25][26][27] Adverse events Although CSs have dramatically improved PV prognosis, they come with various well-documented cutaneous, metabolic, and systemic complications. 28 Postmenopausal women are the group most vulnerable to primary osteoporosis, and CSs can expose them to higher risk. 29 The chronic use of CSs in women can also harm reproductive function.…”

“…74,75 Finally, long-term immunosuppressive therapy with CSs may cause disturbance in psychiatric health (depression, mania, and cognitive impairment), known as the most common adverse event of steroids according to the Glucocorticoid Toxicity Index. 28 The data regarding the relationship between pemphigus and psychiatric disorders is still in its infancy. Further studies are needed to determine the pathophysiology of this association to lessen the psychological burden of the disease.…”