“There is always a need for ongoing attention to mitigating steroid toxicity when prescribing glucocorticoids, and it is particularly valuable to have validated measures of glucocorticoid toxicity that can be used to measure toxicity over time - both in clinical trials and in clinical care as well.”
Jeffrey Gelfand MD MAS is an Associate Professor of Neurology at UCSF and specializes in caring for patients with a wide range of neuroinflammatory disorders. He is an award-winning medical educator and alongside caring for patients conducts clinical research focused on advancing new treatments for neuroimmunological diseases and restoring neurological function.
Dr. Gelfand is fascinated by the human brain, as the brain makes us the people and individuals that we are. He is also intrigued by the immune system and how it can affect how the brain and nervous system function.
He explains there are many types of neuroinflammatory conditions, where the immune system gets misdirected and attacks the nervous system. These can cause substantial consequences for the patient and notes: “I’m passionate about developing better ways of caring for patients and trying to find better diagnostics and more sustainable ways of treating patients with the goal of restoring their neurologic function and supporting the lives that people want to live.
And I think what also particularly draws me to this area is that I truly believe that we can get there. We’re on the cusp of making great advances as a field, and I really, really believe this is a very special time in clinical neuroscience.”
Dr. Gelfand continued by explaining that for many neuroinflammatory conditions, glucocorticoids are a mainstay, frontline treatment because they tend to work well and work very quickly to target harmful inflammation.
“In the brain, in particular, time is of the essence - we need to stop the inflammation as quickly as possible. Glucocorticoids reduce inflammation systemically and in the nervous system very quickly, which is crucial as inflammation can cross the blood-brain barrier very effectively. However, a challenge clinically is that glucocorticoids are time and dose limited, and with extended use they carry a substantial risk for toxicity.”
He continues by explaining there are many oral, injectable, and infusible “steroid-sparing” alternatives to glucocorticoids, that have the important benefit of not causing steroid toxicity while still treating harmful inflammation.
“Steroid toxicity is an important consideration whenever glucocorticoids are used, including in neurology, and I believe most neurologists are well aware of the toxicity concerns. That being said, measuring and monitoring steroid toxicity can be challenging and requires an interdisciplinary focus. While some of the toxicities are immediately bothersome and visible to both patient and clinician, others may build up more silently such as hyperlipidemia, blood sugar elevations, or effects on bone health.”
“There is always a need for ongoing attention to mitigating steroid toxicity when prescribing glucocorticoids, and it is particularly valuable to have validated measures of glucocorticoid toxicity that can be used to measure toxicity over time - both in clinical trials and in clinical care as well.”
He continues by explaining there are many new immunosuppressive steroid-sparing therapies that may not necessarily be MORE effective than glucocorticoids, but if they are AS effective and reduce risk and lower morbidity they would be very appealing to both patients and clinicians.
“In many clinical contexts, including the treatment of neuroinflammatory diseases, one important treatment goal is to be able to reduce cumulative glucocorticoid use over time to lessen the risk of steroid toxicity, while still effectively controlling the disease.”
“Having a quantitative measure of a reduction in toxicity and morbidity is incredibly valuable to help interpret whether a reduction in glucocorticoids is a net positive for the patient.”
Jeffrey Gelfand MD MAS is an Associate Professor of Neurology at UCSF and Assistant Medical Director for the MS and Neuroinflammation Clinic. He received his MD from Harvard Medical School and completed an internship in internal medicine, residency in neurology, and subspecialty fellowship training in MS/neuroimmunology, all at UCSF. Dr. Gelfand went on to earn a Masters in Advanced Study in clinical research at UCSF and is board-certified in neurology.