Evaluation of the steroid sparing effects of Mepolizumab using the Glucocorticoid Toxicity Index

Research output: Contribution to conferencePoster


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 languageEnglish
Publication statusPublished - 2019
EventEuropean Respiratory Society International Congress 2019 - Spain, Madrid, Spain
Duration: 28 Sept 201902 Oct 2019


ConferenceEuropean Respiratory Society International Congress 2019
Abbreviated titleERS 2019
Internet address


Dive into the research topics of 'Evaluation of the steroid sparing effects of Mepolizumab using the Glucocorticoid Toxicity Index'. Together they form a unique fingerprint.

Cite this