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

Yicong Liang; Faith A P Zeng; Tabrez Sheriff; Anna Wilson; Asli Bilgic; Grant Feng; John H Stone; Dedee F Murrell

doi:10.1016/j.jdin.2021.09.003

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

JAAD Int. 2022 Jan 12:6:68-76. doi: 10.1016/j.jdin.2021.09.003. eCollection 2022 Mar.

Authors

Yicong Liang^{1

2}, Faith A P Zeng^{1

2}, Tabrez Sheriff^{1

2}, Anna Wilson^{1

2}, Asli Bilgic^{1

2

3}, Grant Feng⁴, John H Stone⁵, Dedee F Murrell^{1

2}

Affiliations

¹ Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.
² Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Dermatology, Akdeniz University, Antalya, Turkey.
⁴ Data Science, WooliesX, Sydney, New South Wales, Australia.
⁵ Department of Rheumatology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.

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.

Keywords: ABQOL, Autoimmune Bullous Disease Quality of Life; AIBD, autoimmune blistering disease; Autoimmune blistering disease; BMI, body mass index; GCAE, glucocorticoid-induced adverse effect; GTI, Glucocorticoid Toxicity Index; GTI-AIS, Glucocorticoid Toxicity Index Aggregate Improvement Score; GTI-CWS, Glucocorticoid Toxicity Index Cumulative Worsening Score; Glucocorticoid Toxicity Index; clinical research; glucocorticoid; side effect.