Glucocorticoid Toxicity Index Useful for Morbidity in Lupus Nephritis

In patients with lupus nephritis (LN), the glucocorticoid toxicity index (GTI) may serve as a useful outcome predictor in future LN trials assessing the steroid-sparing effect of new therapies, according to a study published in Lupus. Vasileios C. Kyttaris, MD, and colleagues conducted a retrospective cohort study of 49 patients with biopsy-confirmed LN between 2006 and 2016. Medical records were reviewed to determine cumulative glucocorticoids (GC) exposure and GTI scores. Both the cumulative worsening score (GTI-CWS) and the aggregate improvement score (GTI-AIS) were measured. At 1 and 5 years after kidney biopsy, linear regression was used to determine the link between GC exposure and GTI scores. At 1 year, GC exposure was not linked with GTI scores. However, at 5 years, higher GC exposure was linked with greater GTI-AIS (P<0.001) and GTI-CWS (P=0.002). This link endured in multivariate analysis adjusting for sex, race, age, induction medication, and nephritis class (P=0.026 for AIS; P=0.012 for CWS).