A new study led by Joyce Chang, MD MSCE from Boston Children's Hospital and Harvard Medical School, along with researchers from the Children's Hospital of Philadelphia, has underscored the pressing need for better management of glucocorticoid toxicity in patients with pediatric systemic lupus erythematosus (pSLE).
The study, published in Seminars in Arthritis and Rheumatism,[1] found significant occurrence of growth delay and mood disturbances amongst pSLE patients, emphasizing the specific harm steroids can inflict on children during crucial periods of growth and psychosocial development with effects that may possibly extend into adulthood.
The authors highlight the use of the Steritas pediatric Glucocorticoid Toxicity Index (pGTI) as a valuable tool for assessing and managing steroid-related side effects in children, which provides essential insights for clinicians and researchers alike.
The study involved a retrospective cohort analysis of 126 pSLE patients treated at two major pediatric centers - Boston Children's Hospital and the Children's Hospital of Philadelphia - between 1999 and 2023. Researchers utilized the pGTI to measure steroid-toxicity across seven health domains including blood pressure, mood disturbances, body mass index (BMI) and growth velocity. Data were collected at six-month intervals to track changes in toxicity levels over time.
High burden of steroid-toxicity
The findings revealed a significant burden of glucocorticoid toxicity among the pediatric cohort:
- Blood Pressure: Nearly half of the patients (47%) experienced increased blood pressure, the most commonly observed toxicity.
- Mood: Mood disturbances were also prevalent, affecting 25% of the patients.
- BMI: BMI increases affected 21% of the patients.
- Growth Issues: Notably, 18% of patients showed decreased growth velocity, underscoring the profound impact of steroids on children's physical development.
The study also found a modest correlation between the cumulative steroid dose and the Cumulative Worsening Score (CWS), a measure of the total toxicity accumulated over time.
Younger age, elevated BMI and the need to add rituximab to the treatment protocol due to the severity of pSLE were identified as significant risk factors for greater toxicity.
This research emphasizes the importance of standardized, pediatric-specific tools like the pGTI in clinical settings. The ability to quantify and monitor steroid-toxicity enables clinicians to tailor treatments with greater precision, to mitigate the adverse effects associated with long-term steroid use. These findings advocate for steroid-sparing strategies and more judicious use of steroids in pediatric patients with chronic inflammatory conditions like lupus.
A call to action for pediatric rheumatology
The study by Chang, et al. serves as a pivotal step toward enhancing the management of steroid-toxicity in children with pSLE. The authors call for broader application of the pGTI in clinical practice and further research into alternative treatment strategies to reduce steroid dependency.
The authors stress the frequent occurrence of growth delay and mood disturbances underscores the harm steroids can cause in children. This points to the need for the most effective and least harmful steroid-sparing treatments to be made available for young patients.
References
- Emily Zhang, Sarah Capponi, Rebecca Scobell, Gabrielle Alonzi, Madeline Hlobik, Ankana Daga, Esra Meidan, Holly Wobma, Liyoung Kim, Lauren A. Henderson, Siobhan Case, Peter A. Nigrovic, John H. Stone, Karen H. Costenbader, Mary Beth F. Son, Joyce C. Chang, Real-world application of the pediatric Glucocorticoid Toxicity Index in childhood-onset lupus, Seminars in Arthritis and Rheumatism, Volume 68, 2024, 152516, https://doi.org/10.1016/j.semarthrit.2024.152516
Unlock the STOX®
Did you know about Steritas' support for unfunded academic research?
We welcome applications for no-fee academic licenses to the STOX Suite and access to the STOX Digital Platform.
