Evaluation of the steroid sparing effects of Mepolizumab using the Glucocorticoid Toxicity Index
| Autor: | Kirsty Honeyford, Liam G Heaney, John H. Stone, Pamela Jane McDowell, R Jayne Logan, Claire A. Butler, Louise Dunn |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.disease 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Internal medicine Steroid sparing Toxicity Cohort medicine Prednisolone Medical history 030212 general & internal medicine business Mepolizumab Glucocorticoid medicine.drug Asthma |
| Zdroj: | Airway pharmacology and treatment. |
| DOI: | 10.1183/13993003.congress-2019.pa2513 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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