New concepts to reduce glucocorticoid toxicity

Alten, Rieke; Mischkewitz, Max

doi:10.1016/j.jbspin.2018.11.006

Cited by 8 publications

(6 citation statements)

References 34 publications

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“…Fragility fractures can be prevented, but only when assessment and prophylaxis, according to the latest recommendations, are actually implemented [15,42,43]. The same studies that document glucocorticoids-related osteoporosis also show that physicians and patients are woefully inadherent.…”

Section: Discussionmentioning

confidence: 99%

The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

Luís

Boers

Saag

et al. 2022

Current Opinion in Rheumatology

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Purpose of reviewGlucocorticoids justifiably remain a cornerstone in the treatment of many inflammatory rheumatic diseases but many are opposed to their use because of the side effects, most of them known to be dose-dependent. Most concerns regarding glucocorticoids stem from observational studies which are affected by several forms of bias, mainly confounding by indication, that may result in overestimation of harm. Solid evidence regarding the safety of low-dose glucocorticoids remains remarkably scarce. Recent findingsSeveral observational studies showed heterogeneous results and two 6-month trials showed no increase of harm. The GLORIA trial of 5 mg/day prednisolone vs. placebo in patients aged 65þ is the first randomized control trial with glucocorticoids safety as coprimary outcome. The benefits of glucocorticoids in terms of symptoms and structural damage were confirmed, but the proportion of patients with at least one adverse event of special interest (serious or glucocorticoids-related) was increased by 24%, mostly due to nonsevere infections.

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Section: Discussionmentioning

confidence: 99%

The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

Luís

Boers

Saag

et al. 2022

Current Opinion in Rheumatology

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“… 7 The main risk factors associated with GC-induced hyperglycemia/DM are: obesity, advanced age, genetic predisposition, and chronic inflammation. 2 , 4 , 7 Smoking, high blood pressure, and high levels of glycated hemoglobin have also been cited as risk factors. 8 …”

Section: Hyperglycemia and Dmmentioning

confidence: 99%

“…The discovery of this class of medication was so revolutionary for science that Edward Kendall, Tadeusz Reichstein and Philip Hench received the Nobel Prize in Medicine and Physiology after they isolated cortisone, which allowed its medical use. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know

Tavares,

Caetano,

Ianhez

2024

Anais Brasileiros de Dermatologia

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“…Many patients with pemphigus need to receive long‐term and high cumulative doses of GC for disease control, which after a long duration result in debilitating multisystem adverse events. Some GC‐related toxicities include cutaneous adverse events (skin atrophy, telangiectasia, infections, striae rubrae), metabolic adverse events (hyperglycemia, weight gain, Cushing syndrome), and more importantly, systemic complications, namely osteoporosis, cardiovascular diseases, adrenal insufficiency, cataract, and even psychiatric symptoms 4–7 …”

Section: Introductionmentioning

confidence: 99%

“…Some GC-related toxicities include cutaneous adverse events (skin atrophy, telangiectasia, infections, striae rubrae), metabolic adverse events (hyperglycemia, weight gain, Cushing syndrome), and more importantly, systemic complications, namely osteoporosis, cardiovascular diseases, adrenal insufficiency, cataract, and even psychiatric symptoms. [4][5][6][7] The introduction of biological treatments has paved the way for faster tapering and discontinuing of GC. 8 Rituximab (RTX) is a monoclonal anti CD20 antibody that induces rapid, complete, and longlasting B-cell depletion mainly through antibody-dependent cytotoxicity.…”

mentioning

confidence: 99%

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

Mazaherpour

Kianfar

Dasdar

et al. 2022

Dermatologic Therapy

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Rituximab (RTX) combined with short-term glucocorticoids (GC) is an effective therapeutic option for pemphigus. The newly developed Glucocorticoid Toxicity Index (GTI) tool provides the possibility to measure GC toxicities over time. To compare 1-year GTI between two groups of RTX-treated and RTX-naïve patients with pemphigus. The responsiveness of the GTI was also investigated. A prospective cohort of 129 adults with newly diagnosed pemphigus was conducted. GC-related toxicities were assessed at 3-month intervals according to Composite and Specific lists of the GTI. Of the patients, 76.7% (n = 99) received RTX. Throughout the time intervals, RTX-treated patients had lower GTI compared to RTX-naïve ones (p = 0.036). The mean GTI at 1-year was 34.3 in the RTX-treated group and 50.8 in the RTX-naïve group (p = 0.04). The most commonly observed GC-related toxicity was neuropsychiatric manifestations for 34% (224 events). The relapse rate of RTX-treated patients (1%) was significantly lower than RTX-naïve patients (10%) (p = 0.037). The GTI showed no correlation with cumulative GC consumption in both groups (p > 0.05, both). Patients treated with GC alone had remarkably higher GTI than patients treated with GC plus RTX. The GTI is an applicable tool to quantitatively capture GC toxicities at the patient level in pemphigus.

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New concepts to reduce glucocorticoid toxicity

Cited by 8 publications

References 34 publications

The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

The safety of glucocorticoids in the treatment of inflammatory rheumatic disease: new evidence

Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know

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

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