Evidence map›Paper›PMID 39059156›Full record

ArticleSeminars in arthritis and rheumatism2024

Real-world application of the pediatric Glucocorticoid Toxicity Index in childhood-onset lupus.

Emily Zhang, Sarah Capponi, Rebecca Scobell, Gabrielle Alonzi, Madeline Hlobik, Ankana Daga, Esra Meidan, Holly Wobma, Liyoung Kim, Lauren A Henderson and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Seminars in arthritis and rheumatism, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
  5. New Insights on Childhood Lupus Nephritis.International journal of nephrology and renovascular disease · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Emily ZhangDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Sarah CapponiDivision of Rheumatology, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Rebecca ScobellDivision of Rheumatology, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Gabrielle AlonziDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Madeline HlobikDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Ankana DagaDivision of Nephrology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Esra MeidanDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Holly WobmaDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Liyoung KimDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Lauren A HendersonDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Siobhan CaseDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Peter A NigrovicDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
John H StoneDivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Karen H CostenbaderDivision of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Mary Beth F SonDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Joyce C ChangDivision of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: Joyce.Chang@childrens.harvard.edu.

Funding

Cardiovascular Disease Epidemiology in Patients with LupusK24AR066109 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI COSTENBADER, KAREN H · 2014 to 2023
$1.7M
Cardiovascular health assessment & outcomes of systemic lupus erythematosus: bridging pediatric and adult-onset diseaseK23HL148539 · NHLBI · CHILDREN'S HOSP OF PHILADELPHIA · PI CHANG, JOYCE CHUN-LING · 2020 to 2024
$973k
NHLBI NIH HHS K23 HL148539NIAMS NIH HHS K24 AR066109
6 · The paper itself

Abstract

objectivesThe pediatric Glucocorticoid Toxicity Index (pGTI) is a new, pediatric-specific tool to quantify glucocorticoid (GC)-related morbidity in children. We evaluated the feasibility and construct validity of retrospective pGTI scoring in patients with pediatric-onset systemic lupus erythematosus (pSLE) and identified risk factors for cumulative toxicity.

methodsWe conducted a retrospective cohort study of patients with pSLE treated with GCs at two pediatric centers (1999-2023). GC exposure was estimated using interval-averaged oral prednisone-equivalent dose and cumulative prednisone-equivalent dose. We scored change in GC toxicity every 6 months (±2) using a modified pGTI including 7 of 10 domains. We calculated the Cumulative Worsening Score (CWS), a continuous summation of toxicity accrued. Mixed effects linear regression was used to identify factors associated with CWS.

resultsThere were 126 patients with pSLE, including 88 with nephritis, with a median of 6 visits/patient. Nearly half (47 %) experienced toxicity in the Blood Pressure domain. Other common toxicities were mood disturbance (25 %), followed by increased body mass index (BMI), striae, and sleep disturbance (21 % each). Decreased growth velocity was observed in 18 %. There was modest correlation between cumulative GC dose and CWS (rho 0.3; p < 0.01). Greater cumulative toxicity was associated with younger age, elevated BMI, and rituximab use at the time of GC initiation, albeit indications for the latter were not captured.

conclusionsPatients with pSLE experience a high burden of GC toxicity, particularly related to blood pressure, BMI, sleep, and growth. Standardized, pediatric-specific GC toxicity assessment is feasible in real-world settings and can facilitate evaluation of strategies to reduce morbidity in children requiring chronic GC treatment.

Indexed as

GlucocorticoidsLupus Erythematosus, SystemicAdolescentAge of OnsetChildFeasibility StudiesFemaleHumansMaleRetrospective StudiesRisk FactorsGlucocorticoidsDrug-related side effectsGlucocorticoidsLupus nephritisOutcome measurementPediatric rheumatologySystemic lupus erythematosus

Identifiers

PMID39059156
PMCPMC11381140

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