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.
The findings revealed a significant burden of glucocorticoid toxicity among the pediatric cohort:
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.
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.