“Patients receiving oral glucocorticoid treatment for a period of 3-4 years are at twice the risk of death - with heart trouble a leading cause.”
Healthcare in the U.S. is accelerating a shift towards patient-centered or value-based care because a fee-for-service delivery model is no longer deemed to deliver the most efficient care and best outcomes for patients.
KPMG’s 2021 Healthcare CEO Future Pulse report suggests the vast majority of healthcare executives believe all aspects of care delivery models will be transformed within the next three years, with quality of care and patient-centricity being prioritized in transformation programs.
One key measure of care quality is how often patients are readmitted for related items or adverse events from treatments. 1% of the adult population is on long-term glucocorticoid treatments [1], even though long-term exposure is associated with a range of toxicities including an increased risk of devastating adverse events such as fractures, infections, gastrointestinal bleeding [2], and even death [3].
Lupus expert Murray Urotwitz MD FRCP(C) concurs, “If you ask the doctor and patient what they want most of all, their unanimous answer will be, ‘not to have to use steroids.’”
“Many of my articles describe the side effects of corticosteroids: eye atherosclerosis or premature heart disease is in a significant part caused by the glucocorticoids because they give you high blood pressure, high cholesterol, high blood sugar - all the things that lead to heart trouble.”
A recent study published by researchers from the University of Gothenburg, Sweden has shown that patients receiving oral glucocorticoid treatment for a period of 3-4 years are at twice the risk of death compared with a matched control group - with heart trouble a leading cause. Mortality risks increased across the glucocorticoid treatment group, most notably caused by increased incidences of pulmonary embolism (an increase of 2.54x), sepsis (2.07x), pneumonia (1.63x), heart failure (1.55x), and ischemic heart disease (1.33x). [3]
Neuroinflammatory disorder expert Jeffrey Galfand MD MAS adds, “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.”
“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.”
Leading international authority on systemic autoimmune diseases, rheumatic diseases, and osteoporosis Professor Yoshiya Tanaka, sees the GTI as an important instrument to help clinicians safely taper patients off of long-term, high-dose glucocorticoid treatment regimens. “It is important to balance the safety and efficacy of glucocorticoid treatments, and we know that it is not easy to taper patients safely. So if we find a patient’s toxicity scores are worsening we can try an immunosuppressant or a biologic drug and then need to track to see if we can taper the glucocorticoids. When we start the new treatment we have to know the balance between safety and efficacy which we check using the GTI. If the treatment is successful we will continue to check the GTI scores to check for improvement due to the tapering.”
“We have also found that patients are grateful to see the improvement in the GTI scores.”
Tanaka has published several papers using the GTI and is in the process of writing new guidelines for the treatment of autoimmune patients and how glucocorticoid adverse events should be monitored using the GTI. He stresses the importance of these guidelines as they will help to improve the standard of care for patients across Japan.
Similar efforts to update guidelines and standards of patient care are underway across the United States, Canada, UK, and Europe supported by the launch of numerous steroid-sparing therapies.
To learn more about using the Steritas GTI in appoint of care setting, click here.
References
[1] Laurence Fardet, MD, PhD, Irene Petersen, PhD, and Irwin Nazareth, MD, PhD Monitoring of Patients on Long-Term Glucocorticoid Therapy- A Population-Based Cohort Study. Medicine. Volume 94, Number 15, April 2015
[2] Rice JB, White AG, Scarpati LM, Wan G, Nelson WW. Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review. Clin Ther. 2017 Nov;39(11):2216-2229. doi: 10.1016/j.clinthera.2017.09.011. Epub 2017 Oct 19. PMID: 29055500.
[3] Einarsdottir MJ, Ekman P, Molin M, Trimpou P, Olsson DS, Johannsson G, Ragnarsson O. High Mortality Rate in Oral Glucocorticoid Users: A Population-Based Matched Cohort Study. Front Endocrinol (Lausanne). 2022 Jul 8;13:918356. doi: 10.3389/fendo.2022.918356. PMID: 35872995; PMCID: PMC9304700.