Evaluation of the modified combined glucocorticoid toxicity index in rheumatoid arthritis: Preliminary data
https://doi.org/10.14412/1995-4484-2020-26-30
Abstract
Objective: to assess whether the modified combined glucocorticoid (GC) toxicity index (MCGTI) can be used to analyze adverse reactions (ARs) to GCs administered in the management of rheumatoid arthritis (RA).
Subjects and methods. The investigation enrolled 71 RA patients (57 females, 14 males; mean age, 51.7+15.2 years). All the patients met the ACR/EULAR classification criteria and took GCs (the median duration of GC treatment duration was 7.1 [0.9; 12.0] years). In addition to the standard clinical, laboratory, and instrumental indicators, the daily and cumulative doses of GCs (in prednisolone equivalent) and MCGTI were analyzed.
Results and discussion. The value of MCGTI statistically significantly correlated with treatment duration (r=0.411), age (r=0.384), and the cumulative dose of GCs (r=0.361), but did not correlate with their maximum dose (r=0.06). A ROC analysis showed that the critical level of the cumulative dose of GCs in relation to MCGTI was 17,337.5 mg.
Conclusion. MCGTI correlates with cumulative dose (making it possible to establish its critical level), treatment duration, and age, which is the basis for further study of whether this can be applied in clinical practice to evaluate, predict, and prevent ARs.
About the Authors
V. V. Lebedeva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Competing Interests: not
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Competing Interests: not
Yu. V. Muravyev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Competing Interests: not
Russian Federation
Yuri Muravyev
34A, Kashirskoe Shosse, Moscow 115522
Competing Interests: not
S. I. Glukhova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Competing Interests: not
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
Competing Interests: not
References
1. Sokka T, Toloza S, Cutolo M, et al. Women, men, and rheumatoid arthritis: analyses of disease activity,disease characteristics, and treatments in the QUEST-RA study. Arthritis Res Ther. 2009;11:R7.
2. Kirwan JR. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. N Engl J Med. 1995;333(3):142-6. doi: 10.1056/NEJM199507203330302
3. Caldwell JR, Furst DE. The efficacy and safety of low-dose corticosteroids for rheumatoid arthritis. Semin Arthritis Rheum. 1991;21:1-11. doi: 10.1016/0049-0172(91)90051-Z
4. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med. 1994;96:115-23. doi: 10.1016/0002-9343(94)90131-7
5. Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55:420-6. doi: 10.1002/art.21984
6. McDonough AK, Curtis JR, Saag KG. The epidemiology of glucocorticoid-associated adverse events. Curr Opin Rheumatol. 2008;20:131-7. doi: 10.1097/BOR.0b013e3282f51031
7. Huscher D, Thiele K, Gromnica-Ihle E, et al. Dose-related patterns of glucocorticoid induced side effects. Ann Rheum Dis. 2009;68:1119-24. doi: 10.1136/ard.2008.092163
8. Hoes JN, Jacobs JW, Verstappen SM, et al. Adverse events of low-to medium dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis. 2009;68:1833-8. doi: 10.1136/ard.2008.100008
9. Da Silva JA, Jacobs JW, Kirwan JR, et al. Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis. 2006;65:285-93. doi: 10.1136/ard.2005.038638
10. Van der Goes MC, Jacobs JW, Boers M, et al. Patients’ and rheumatologists’perspectives on glucocorticoids an exercise to improve the implementation of the EULAR recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2010 Jun;69(6):1015-21. doi: 10.1136/ard.2009.114579
11. Miloslavsky EM, Naden RP, Bijlsma JW, et al. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis. 2017 Mar;76(3):543-6.
12. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580-8. doi: 10.1136/ard.2010.138461
13. Sarnes E, Crofford L, Watson M, et al. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther. 2011;33:1413-32. doi: 10.1016/j.clinthera.2011.09.009
14. Nasonov EL, Chichasova NV, Kovalev VYu. Glukokortikoidy v revmatologii [Glucocorticoids in rheumatology]. Moscow; 1998. 160 p. (In Russ.).
15. Hoes JN, Jacobs JWG, Boers M, et al. EULAR evidence based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007;66:1560-7. doi: 10.1136/ard.2007072157
16. Caplan L, Wolfe F, Russel AS, et al. Corticosteroids use in rheumatoid arthritis: prevalence, predictors, correlates, and outcome. J Rheumatol. 2007;34:696-706.
17. Chichasova NV. EULAR recommendation for the management of rheumatoid arthritis (2013): glucocorticoid use. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2014;8(2):28-34 (In Russ.). doi: 10.14412/1996-7012-2014-2-28-34
18. Nasonov EL. New guidelines for the management of rheumatoid arthritis (EULAR, 2013): The place of glucocorticoids. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2013;53(3):238-50 (In Russ.). doi: 10.14412/1995-4484-2015-238-250
19. Bel EH, Wenzel SE, Thompson PJ, et al. Oral glucocorticoidsparing effect of mepolizumab in eosinophilic asthma. N Engl J Med. 2014;371:1189-97. doi: 10.1056/NEJMoa1403291
20. Fortunet C, Pers YM, Lambert J, et al. Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice. Rheumatology (Oxford). 2015;54:672-7. doi: 10.1093/rheuma-tology/keu339
Review
For citations:
Lebedeva V.V., Muravyev Yu.V., Glukhova S.I. Evaluation of the modified combined glucocorticoid toxicity index in rheumatoid arthritis: Preliminary data. Rheumatology Science and Practice. 2020;58(1):26-30. (In Russ.) https://doi.org/10.14412/1995-4484-2020-26-30
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