PMID- 32882446
OWN - NLM
STAT- MEDLINE
DCOM- 20210521
LR  - 20220531
IS  - 2213-2201 (Electronic)
VI  - 9
IP  - 1
DP  - 2021 Jan
TI  - Quantification of Glucocorticoid-Associated Morbidity in Severe Asthma Using the 
      Glucocorticoid Toxicity Index.
PG  - 365-372.e5
LID - S2213-2198(20)30864-3 [pii]
LID - 10.1016/j.jaip.2020.08.032 [doi]
AB  - BACKGROUND: Glucocorticoid (GC)-associated morbidity in severe asthma (SA) is 
      well recognized but varies in individual patients; systematic measurement of GC 
      toxicity is important to measure improvement with steroid-sparing monoclonal 
      antibodies. OBJECTIVE: To describe for the first time individual patient GC 
      toxicity in steroid-dependent SA using the Glucocorticoid Toxicity Index (GTI). 
      METHODS: An observational consecutive patient cohort study was performed at a UK 
      Regional SA Specialist clinic for systematic assessment of GC-associated 
      morbidity using the GTI in routine clinical care. GTI was correlated with 
      commonly used patient-reported outcome measures. An approach to GTI scoring, 
      calculation of minimal clinically important difference (MCID), and development of 
      digital GTI application in routine clinical care are described. RESULTS: All 
      patients had significant oral GC exposure (cumulative prednisolone/prior year, 
      4280 [3083, 5475] mg) with wide distribution of toxicity in individual patients 
      (mean GTI score, 177.5 [73.7]). GTI score had only modest correlation with recent 
      prednisolone exposure: maintenance prednisolone dose (rho = 0.26, P = .01), 
      cumulative exposure/prior year (rho = 0.38, P < .001), and GC boosts/prior year 
      (rho = 0.25, P = .01). GTI toxicity demonstrated stronger associations with 
      asthma-related quality of life (mini-Asthma Quality of Life Questionnaire 
      [mini-AQLQ] r = -0.50, P < .001 and St. George's Respiratory Questionnaire r = 
      0.42, P < .001). GTI MCID was calculated as 10 points. Multiple linear regression 
      demonstrated that age and mini-AQLQ were strongest predictors of GC toxicity. 
      CONCLUSIONS: The GTI is a useful tool to systematically capture and quantify GC 
      toxicity at the individual patient level. GC toxicity varies widely between 
      individual patients with SA and correlated only modestly with GC exposure over 
      the preceding year. Age and mini-AQLQ are better predictors of GC toxicity. The 
      GTI and MCID will facilitate assessment of individual SA response to 
      steroid-sparing agents in clinical trials and routine care.
CI  - Copyright (c) 2020 American Academy of Allergy, Asthma & Immunology. Published by 
      Elsevier Inc. All rights reserved.
FAU - McDowell, P Jane
AU  - McDowell PJ
AD  - Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological 
      Sciences, Queen's University Belfast, Belfast, United Kingdom.
FAU - Stone, John H
AU  - Stone JH
AD  - Division of Rheumatology, Allergy, and Immunology, Massachusetts General 
      Hospital, Harvard Medical School, Boston, Mass.
FAU - Zhang, Yuqing
AU  - Zhang Y
AD  - Division of Rheumatology, Allergy, and Immunology, Massachusetts General 
      Hospital, Harvard Medical School, Boston, Mass.
FAU - Honeyford, Kirsty
AU  - Honeyford K
AD  - Department of Respiratory Medicine, Belfast City Hospital, Belfast Health and 
      Social Care Trust, Belfast, United Kingdom.
FAU - Dunn, Louise
AU  - Dunn L
AD  - Department of Respiratory Medicine, Belfast City Hospital, Belfast Health and 
      Social Care Trust, Belfast, United Kingdom.
FAU - Logan, R Jayne
AU  - Logan RJ
AD  - Department of Respiratory Medicine, Belfast City Hospital, Belfast Health and 
      Social Care Trust, Belfast, United Kingdom.
FAU - Butler, Claire A
AU  - Butler CA
AD  - Department of Respiratory Medicine, Belfast City Hospital, Belfast Health and 
      Social Care Trust, Belfast, United Kingdom.
FAU - McGarvey, Lorcan P A
AU  - McGarvey LPA
AD  - Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological 
      Sciences, Queen's University Belfast, Belfast, United Kingdom.
FAU - Heaney, Liam G
AU  - Heaney LG
AD  - Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological 
      Sciences, Queen's University Belfast, Belfast, United Kingdom. Electronic 
      address: l.heaney@qub.ac.uk.
LA  - eng
GR  - MR/M016579/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Observational Study
DEP - 20200901
PL  - United States
TA  - J Allergy Clin Immunol Pract
JT  - The journal of allergy and clinical immunology. In practice
JID - 101597220
RN  - 0 (Glucocorticoids)
SB  - IM
CIN - J Allergy Clin Immunol Pract. 2021 Jan;9(1):373-374. PMID: 33429709
MH  - *Asthma/drug therapy/epidemiology
MH  - *Glucocorticoids/therapeutic use
MH  - Humans
MH  - Morbidity
MH  - Quality of Life
MH  - Surveys and Questionnaires
OTO - NOTNLM
OT  - Corticosteroid toxicity
OT  - Glucocorticoids
OT  - Morbidity
OT  - Severe asthma
EDAT- 2020/09/04 06:00
MHDA- 2021/05/22 06:00
CRDT- 2020/09/04 06:00
PHST- 2020/05/19 00:00 [received]
PHST- 2020/07/12 00:00 [revised]
PHST- 2020/08/13 00:00 [accepted]
PHST- 2020/09/04 06:00 [pubmed]
PHST- 2021/05/22 06:00 [medline]
PHST- 2020/09/04 06:00 [entrez]
AID - S2213-2198(20)30864-3 [pii]
AID - 10.1016/j.jaip.2020.08.032 [doi]
PST - ppublish
SO  - J Allergy Clin Immunol Pract. 2021 Jan;9(1):365-372.e5. doi: 
      10.1016/j.jaip.2020.08.032. Epub 2020 Sep 1.