A scoping review to identify clinician reported measurement instruments of glucocorticoid toxicity for the OMERACT Glucocorticoid Impact working group

Background/aims

Glucocorticoids (GCs) are widely used to treat autoimmune rheumatic diseases (AIRDs). Despite well-recognised adverse effects (AEs) including osteoporosis, diabetes, infection and psychiatric comorbidities, GC impact has not been well quantified in clinical trials nor standardised across indications for use. The OMERACT GC Impact Working Group established a core domain outcome set in 2021. Further work was required to establish appropriate measurement instruments for these core domains. This scoping review aims to identify clinician reported outcome measures (ClinROs) of GC-related AEs in patients with inflammatory conditions treated with GCs.

Methods

Medline, EMBASE, CINHAL and CENTRAL were searched (from inception to August 2024) along with hand search of abstracts presented at major rheumatology meetings (between August 2019 and August 2024), for studies referring to the use of exogenous GCs and reporting a clinician or patient reported outcome measure (PRO). Data was extracted for each OMERACT GC domain.

Results

57 studies included ClinROs, 20 (35.1%) in an AIRD population. In the majority (48/57, 84.2%) GCs were delivered systemically. Bone fragility (n = 31 studies) and mood disturbance (n = 20) were frequently assessed, while fatigue (n = 0), sleep disturbance (n = 2) and appearance (n = 1) were infrequently assessed. 31 individual or grouped candidate ClinROs were identified.

Conclusion

31 candidate ClinROs were identified for measurement of physiological and psychosocial impact domains of GC impact. These findings will inform selection of a core set of measurement instruments for future trials and clinical practice.