Glucorticoid Toxicity Index Save

Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids (GC). 

The history, low-cost, efficacy and accessibility of GC have benefitted many and harmed some. This is clearly dose and duration related. The GTI was developed as a practical measure to guide GC use and help reduce the over-reliance on steroids.

The GTI was developed in 2017, simplifies the scoring of steroid-toxicities by generating a Cumulative Worsening Score (CWS) and Aggregate Improvement Score (AIS). Higher scores indicate increased steroid-toxicity. The GTI can be applied to several therapeutic areas (asthma, arthritis, lupus) to reduce steroid dependence and potentially shift to novel steroid-toxicity sparing agents.

Drugs under development are now targeting steroid reduction via treatment innovations. Such is the case with IL-6 inhibitors in GCA and PMR and with avacopan in ANCA-associated vasculitis.  In the ADVOCATE trial, GTI was a secondary outcome measure used to assess whether avacopan treatment reduced CWS and AIS and demonstrated statistically significant reductions in steroid-toxicity. 

Ongoing research will test the ability of the GTI to track steroid-toxicity in other disoreders such as myasthenia gravis, and inflammatory arthritis.

In the development of novel steroid-sparing therapies, the GTI can be use to limit toxicities and optimize outcomes, while also guiding the clinician on when and how to use such steroid sparing interventions.