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Real-world application of the pediatric Glucocorticoid Toxicity Index in childhood-onset lupus

Emily Zhang1, Sarah Capponi2, Rebecca Scobell2

  • 1Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.

Seminars in Arthritis and Rheumatism
|July 26, 2024
PubMed

Insights

The pediatric Glucocorticoid Toxicity Index (pGTI) effectively measures glucocorticoid (GC) harm in children with lupus. This tool identified high GC toxicity rates in pediatric systemic lupus erythematosus (pSLE) patients, highlighting key risk factors.

Area of Science:

  • Pediatric Rheumatology
  • Pharmacovigilance
  • Clinical Toxicology

Background:

  • Glucocorticoids (GCs) are essential for managing pediatric systemic lupus erythematosus (pSLE) but are associated with significant morbidity.
  • Quantifying GC-related toxicity in children is challenging due to a lack of pediatric-specific validated tools.
  • Understanding cumulative GC toxicity is crucial for optimizing treatment strategies and improving patient outcomes.

Purpose of the Study:

  • To evaluate the feasibility and construct validity of the pediatric Glucocorticoid Toxicity Index (pGTI) for retrospective scoring in children with pSLE.
  • To identify risk factors associated with cumulative GC toxicity in this patient population.
  • To establish a standardized method for assessing GC-induced harm in pediatric patients.

Main Methods:

  • A retrospective cohort study involving 126 patients with pSLE treated with GCs at two pediatric centers.
  • Utilized a modified pGTI tool to score GC toxicity every 6 months, calculating a Cumulative Worsening Score (CWS).
  • Employed mixed effects linear regression to identify factors associated with CWS, analyzing GC exposure and patient characteristics.

Main Results:

  • High rates of GC toxicity were observed, with 47% experiencing blood pressure issues, and common toxicities including mood disturbance (25%), increased BMI (21%), striae (21%), and sleep disturbance (21%).
  • Decreased growth velocity was noted in 18% of patients.
  • Cumulative GC dose showed a modest correlation with CWS (rho 0.3; p < 0.01), and younger age, elevated BMI, and rituximab use were associated with greater toxicity.

Conclusions:

  • Pediatric patients with pSLE experience substantial GC-related morbidity, particularly affecting blood pressure, BMI, sleep, and growth.
  • Retrospective scoring using the pGTI is feasible and demonstrates construct validity in real-world settings.
  • The pGTI can aid in evaluating interventions aimed at mitigating GC toxicity in children requiring long-term GC therapy.
Abstract

Keywords:
Drug-related side effectsGlucocorticoidsLupus nephritisOutcome measurementPediatric rheumatologySystemic lupus erythematosus

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