“Every milligram that helps control the disease is a good milligram, but every milligram we can spare is an even better one.”
Frank Buttgereit, MD is a Professor of Rheumatology and Deputy Head of the Department of Rheumatology and Clinical Immunology at the Charité University Medicine (CCM) in Berlin. He also directs a liaison research group at the Deutsche Rheuma-Forschungszentrum.
Professor Buttgereit has expertise in the treatment of a wide variety of musculoskeletal and rheumatic diseases and is internationally recognized for his work on mechanisms and clinical effects of glucocorticoids and on the bioenergetics of immune functions. He has been principal investigator and site investigator for numerous clinical studies into the effects of anti-inflammatory and immunomodulatory agents in patients with rheumatic disease and was a co-author on the project that developed the Glucocorticoid Toxicity Index (GTI).
His research interests include mechanisms of action and clinical usage of glucocorticoids, immunometabolism (regarding questions of how immune cells function biochemically), and developing three-dimensional biological models to replace the need for animal models.
“Glucocorticoids are fascinating. They are extremely helpful: they can save lives, reduce symptoms, and improve health quality. They work rapidly in the majority of patients, and if we did not have them, patients would still be suffering from a lot of problems.
Having said this, glucocorticoids are no angels. The other side of them, especially at higher doses and when used for long durations, is that they potentially cause a lot of side effects.
This means we have to be very careful with them. I always say every milligram that helps control the disease is a good milligram, but every milligram we can spare is an even better one.”
He first became interested in glucocorticoid effects on immune functions during his undergraduate studies and wanted to understand how these powerful compounds that have so many clinically desirable effects, but also so many damaging side effects, work in cells. He conducted basic laboratory research in Berlin, Cambridge and Sydney, focusing on classical genomic and rapid (immunometabolic) non-genomic mechanisms of glucocorticoid action. He subsequently became a clinician working in the field of rheumatology. Driven by his glucocorticoid research, he developed a special focus on bone, becoming a certified DVO (Dachverband Osteologie - translation: German Osteology Society) osteologist.
His research focus brought him into contact with John H. Stone, MD MPH, and he quickly became part of the team of international sub-speciality experts that developed the Steritas GTI.
“I think it's a very good idea to ensure glucocorticoid toxicity is quantified over time. The GTI not only measures the negative effects of glucocorticoids but also measures the positive effects of changes to treatment regimens and the introduction of glucocorticoid-sparing agents.
The GTI is being used in many trials around the world and the development of the GTI-MD should enable the majority of rheumatologists to quantify glucocorticoid toxicity in day-to-day practice.”
When Professor Buttgereit does prescribe glucocorticoids, he provides a lot of guidance to patients.
“I usually explain that glucocorticoids have two sides: They will help reduce pain, and other signs and symptoms of disease - but, they are likely to cause side effects, and adverse events can occur. It's really important to explain the pros and cons of the treatment with these drugs so patients trust you with their treatment and don’t turn to the internet to start reading articles, that may lack sufficient scientific depth.”
He stresses that it is really important that patients build trust with their clinicians and don’t just suddenly stop taking the glucocorticoids as that can lead to serious medical problems for the patient.
“Glucocorticoids need to be carefully tapered as they are such powerful drugs, and outside of clinical trial protocols, there is not a one-size-fits-all approach. It takes an experienced doctor to ensure the glucocorticoids can be tapered successfully and safely.”
The longer the patient has been taking glucocorticoids, the longer the period of tapering usually needs to be so the body can adjust.
“There is a lot of research into new treatments and regimens. The search is for glucocorticoid receptor ligands that provide the benefits of glucocorticoids while minimizing or avoiding unwanted side effects.
Whether through the use of combination therapies, where certain enzyme inhibitors are added to the glucocorticoid therapy to minimize unwanted side effects, or new entities that specifically inhibit the desired immune pathways, there are a lot of exciting developments on the horizon that will hopefully shift the risk-to-benefit ratio in the future.”
Frank Buttgereit, MD is a Professor of Rheumatology and Deputy Head of the Department of Rheumatology and Clinical Immunology at the Charité University Medicine (CCM) in Berlin. He also directs a liaison research group at the Deutsche Rheuma-Forschungszentrum.
He has more than 25 years of clinical expertise in the field of rheumatology, osteology and both laboratory and clinical research on glucocorticoids. He studied Medicine at the Humboldt University Berlin, Charité, became Associate Professor/Senior Registrar in 1997 and has held the position of Professor of Rheumatology at the Charité since 2002. He has been appointed honorary professor for rheumatology at the Rosario University of Bogota, Colombia.
Professor Buttgereit has been the recipient of research awards in 1988 (Humboldt Prize), 2002 (Schuler Award) and many other awards together with his research team since then. He has received scholarships in 1990 (Boehringer Ingelheim Foundation), 1992-94 and 1996 (DAAD), and a BIH Clinical Fellowship (2017 – 2023). He has served or is currently serving on the editorial boards of several journals, including Ann Rheum Dis, Rheumatology, Arthritis Research & Therapy, Z Rheumatol and Inflammopharmacology, and is the author of more than 390 publications.