What is it about?
Anti-neutrophil cytoplasm antibodies (ANCA) associated vasculitis (AAV) is an autoimmune disease. Induction remission and maintenance treatment typically includes high dose, tapering glucocorticoids (GC) in addition to other immunosuppressive medication. The use of Glucocorticoid Toxicity Index (GTI), provides a global, quantifiable assessment tool in which clinicians can assess GC associated morbidity. Recent trials in AAV have exposed the need for systemic assessment of GC burden. In our retrospective cohort study we looked at 43 patients with biopsy proven AAV from a single centre between 2012 to 2016 and followed up for 48 months. The GTI table made up of adverse features was used to quantify patients GC toxicity. Our results showed statistical significance in the association of cumulative GC doses and GTI scores. Adverse features relating to mood disturbance and GC induced psychosis occurred early, in contrast to adrenal insufficiency which typically presented later in the follow up. Infection related adverse events were consistent throughout. We demonstrated that higher, cumulative doses of steroids in AAV lead to worse glucocorticoid related toxicity. Using the GTI creates potential to individualise and quantify the adverse effects patients experience as a result of GC treatment and permits more patient centred management. Whilst glucocorticoids remain the main adjunctive immunosuppression of AAV treatment, the narrow therapeutic window supports the need for GC-sparing treatments.
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Why is it important?
Key Points: 1. Glucocorticoid Toxicity Index provides a global quantifiable assessment tool to assess glucocorticoid associated morbidity 2. Cumulative doses of steroids in ANCA associated vasculitis leads to worse glucocorticoid related toxicity 3. Whilst glucocorticoids remain the mainstay of AAV treatment, the narrow therapeutic window supports the need for GC-sparing treatments
Perspectives
Steroids are used in a number of autoimmune conditions are are often the mainstay of treatment. Many patients remain on GC therapy for a long time and its important to understand and be able to quantify the potential adverse effects of this therapy. The role of GC sparing agents is vital to patients overall wellbeing and quality of life.
Lauren Floyd
Read the Original
This page is a summary of: Glucocorticoid therapy in ANCA Vasculitis - using the Glucocorticoid Toxicity Index as an outcome measure, Kidney360, April 2021, American Society of Nephrology,
DOI: 10.34067/kid.0000502021.
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