Monitoring glucocorticoid treatment in patients followed in rheumatology clinic

Bahap Kara, M., Monitoring Glucocorticoid Treatment In Patients Followed in Rheumatology Clinic, Hacettepe University Graduate School Health Sciences, Pharmacy Department of Clinical Pharmacy Doctor of Philosophy Thesis, Ankara, 2024. Glucocorticoid toxicity index (GTI) is an assessment tool that measures glucocorticoid-related toxicity and its change over time. This study aimed to assess the glucocorticoid therapy of patients in a rheumatology outpatient clinic using the GTI and to identify and prevent glucocorticoid-related problems. This study was conducted prospectively at Hacettepe University Hospitals between January 2021– June 2022. Patients with inflammatory arthritis, connective tissue disease, or vasculitis who were newly prescribed [glucocorticoid (GC)-naive] or have still receiving glucocorticoid therapy within the last 2 years (GC-experienced) were assessed by a multidisciplinary team at baseline, 3rd month, and 6th month using the GTI. Drug-related problems were identified by a clinical pharmacist and categorised using the Pharmaceutical Care Network Europe version-9 system. The study included 156 patients and it was observed that glucocorticoid-related toxicities were higher in the GC-naive group (n=76), whereas changes in toxicity parameters were more limited in the GC-experienced group (n=80). A high cumulative dose of glucocorticoids was found to be associated with higher GTI scores in both groups (p<0.001). In the GC-naive group, patients with vasculitis showed higher GTI scores than patients with inflammatory arthritis (p<0.001). A total of 236 glucocorticoid-related problems were identified in 66% of patients, the majority of which were adverse drug events (94.1%); the most common causes of problems were lack of monitoring of glucocorticoid therapy (41.5%) and lack of drug therapy despite existing indication (39.8%). As a result of 381 interventions, 80.1% of the problems were resolved. The GTI is effective in assessing glucocorticoid toxicity and measuring its change over time. Routine use of the GTI and integration of the clinical pharmacist into the multidisciplinary rheumatology team will allow individual assessment and patient-centred management of glucocorticoid-related problems experienced by patients.