Assessing glucocorticoid toxicity: are the measures sensitive enough?

The Glucocorticoid Toxicity Index (GTI) is a composite instrument designed to capture change in glucocorticoid-related morbidity over time. 1 Stone JH McDowell PJ Jayne DRW et al. The Glucocorticoid Toxicity Index: measuring change in glucocorticoid toxicity over time. Semin Arthritis Rheum. 2022; 55152010 Crossref PubMed Scopus (12) Google Scholar It was developed through consensus methods and multicriteria decision making among 19 medical specialists, with relative domain weights decided via clinician consensus. 2 Miloslavsky EM Naden RP Bijlsma JW et al. Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis. Ann Rheum Dis. 2017; 76: 543-546 Crossref PubMed Scopus (113) Google Scholar The GTI has now been used in more than 45 studies, including 12 phase 3 clinical trials. 1 Stone JH McDowell PJ Jayne DRW et al. The Glucocorticoid Toxicity Index: measuring change in glucocorticoid toxicity over time. Semin Arthritis Rheum. 2022; 55152010 Crossref PubMed Scopus (12) Google Scholar Glucocorticoid Toxicity Index scores by domain in patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with avacopan versus standard prednisone taper: post-hoc analysis of data from the ADVOCATE trialReplacing a standard prednisone taper with avacopan in patients with ANCA-associated vasculitis reduced glucocorticoid toxicity in multiple GTI domains. For individual patients, glucocorticoid toxicity was often nuanced, improving in some domains while worsening in others. These findings emphasise the value of a composite measure of glucocorticoid toxicity that quantifies cumulative worsening and aggregate change directly. Full-Text PDF