Abstract
Background: The Glucocorticoid Toxicity Index(GTI) systematically captures steroid toxicity and measures change in glucocorticoid(GC) associated morbidity using two scores. The Cumulative Worsening Score(CWS) is an additive record of all GC-toxicities encountered by a patient therefore the score is always >0, unless no toxicity has occurred. The Aggregate Improvement Score(AIS) counts present toxicity allowing both improvement and worsening; a negative score reflects reduced toxicity.
Objective: Use the GTI to assess GC-associated morbidity in a severe asthma cohort commencing Mepolizumab(MEPO) in routine clinical care.
Methods: Patients with GC-dependent asthma underwent GTI assessment on commencing MEPO(V1) and after 12 months on MEPO(V2). The validated GTI includes focused medical history, examination, medication review, observations, HbA1c and LDL.
Results: 22 patients(15F:7M), mean age 52.4 y(range 30.5-68.3). Cumulative prednisolone (PRED) in 12 months preceding V1 was 7446mg(range 1400-22,460), mean daily PRED 20.4mg. Cumulative PRED in V1-V2 was 4754mg (range: 0-16,940), mean 12.9mg/day.
14 (64%) had a CWS of 0 indicative of no new GC-toxicity between V1-2; 8(36%) patients had a CWS of >0 (median 30, range 19-93) indicating increased toxicity in at least 1 domain. 19(86%) had a negative AIS, indicating overall improvement in GC-toxicity (mean AIS -56.5).
A rising CWS was associated with age [OR= 1.27 (1.01-1.60)] and higher mean daily PRED dose [OR=1.19 (0.92-1.53)].
Conclusion: MEPO reduces PRED requirements with associated reduction in GC-toxicity over a 1-year period as measured by the GTI. Age and mean daily dose are risk factors for worsening GC toxicity despite dose reduction.
| Original language | English |
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| Publication status | Published - 2019 |
| Event | European Respiratory Society International Congress 2019 - Spain, Madrid, Spain Duration: 28 Sept 2019 → 02 Oct 2019 https://www.ers-education.org/events/international-congress/madrid-2019/ |
Conference
| Conference | European Respiratory Society International Congress 2019 |
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| Abbreviated title | ERS 2019 |
| Country/Territory | Spain |
| City | Madrid |
| Period | 28/09/2019 → 02/10/2019 |
| Internet address |