POS1269 GLUCOCORTICOID TOXICITY IN PATIENTS WITH IgG4-RELATED DISEASE WITHIN THE FIRST YEAR OF TREATMENT
Authors: A. M. Mora Rosas, E. Martin Nares, G. Hernandez-Molina, E. U. Cortez Domínguez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Patients with IgG4-related disease (IgG4-RD) often require long-term glucocorticoid therapy. The prevalence, types, and underlying factors of glucocorticoid toxicity in IgG4-RD patients remain unknown. We aimed to describe the prevalence, types, and associated factors of glucocorticoid toxicity in our IgG4-RD cohort. <h3>Objectives:</h3> To know the prevalence and types of glucocorticoid toxicity in patients with IgG4-RD and according to the clinical phenotype of the disease. <h3>Methods:</h3> We retrospectively included patients diagnosed with IgG4-related disease (IgG4-RD) based on the Comprehensive Diagnostic Criteria and/or the 2019 ACR/EULAR classification criteria who had received glucocorticoid treatment for a minimum of one month and were followed up for at least one year. We categorized them into clinical phenotypes: pancreatobiliary (group 1), retroperitoneal/aortic (group 2), head and neck limited (group 3), Mikulicz/systemic (group 4), and undefined (group 5). From the medical records, we collected demographic, clinical, and treatment variables. We focused on prednisone usa during the first year of treatment, including the mean daily dose of prednisone, accumulated prednisone dose, maximum prednisone dose, and duration of prednisone treatment. To assess glucocorticoid toxicity, we employed the definitions proposed in the Glucocorticoid Toxicity Index, along with its domains and appendixes. <h3>Results:</h3> Fifty-seven patients were included with a mean age of 53±15.8 years, of whom 34 (59.6%) were male. Fifteen (26.3%) belong to group 1, six (10.5%) to group 2, 13 (22.8%) to group 3, 19 (33.3%) to group 4 and 4 (7%) to group 5. The mean prednisone daily dose was 15.9±6.9 grm the median accumulated prednisone dose was 4,967.5 (IQR 3,195-6,670) gm, the mean maximum dose of prednisone was 39.3±14.2 gm, while the median number of days under prednisone treatment was 303.2 ± 103.9 days. Forty-two (73.7%) patients developed one or more toxicities. The first toxicity was documented at a median of 64 (IQR 34.5-132) days. The median number of toxicities was 3 (IQR 1-4). The frequency and types of toxicities reported during the study period (non-mutually exclusive) are summarized in Table 1. There were no differences in daily, accumulated, and maximum prednisone dose, or days with prednisone treatment, development of toxicities, days to first toxicity or number of toxicities according to sex or clinical phenotypes. Patients in group 3 and 4 presented more endocrinologic/metabolic toxicities compared to the other groups. Patients who experienced toxicities had a higher accumulated prednisone dose (5,605 [IQR 4.215-7,015] vs. 3,400 gm [IQR 2,025-5,638], p=0.03), maximum prednisone dose (42.5±12.8 vs. 30.2±14.5 gm, p=0.003) and days of prednisone treatment (321.3±96.7 vs. 252.6±110, p=0.02) than patients without toxicities (Figure 1). Patients that used immunosuppressors did not present lower accumulated prednisone doses (5,335 [IQR 4,132-6,314] vs. 4,272.5 gm [IQR 2,100-7,427], p=0.41) or a lower incidence of toxicities (29 [74.4%] vs. 13 [72.2%], p=0.23). <h3>Conclusion:</h3> Our findings highlight the high prevalence of glucocorticoid toxicity in patients with IgG4-RD undergoing glucocorticoid therapy, even within a relatively brief timeframe of one year. The presence of glucocorticoid toxicity was associated with higher doses and a longer use of prednisone. <h3>REFERENCES:</h3> [1] Lanzillotta M, Campochiaro C, Mancuso G, Ramirez GA, Capurso G, Falconi M, Dagna L, Della-Torre E. Clinical phenotypes of IgG4-related disease reflect different prognostic outcomes. Rheumatology (Oxford). 2020 Sep 1;59(9):2435-2442. [2] Yoshifuji H, Umehara H. Glucocorticoids in the treatment of IgG4-related disease-Prospects for new international treatment guidelines. Mod Rheumatol. 2023 Mar 2;33(2):252-257. <b>Table 1.</b> Frequency of glucocorticoid-related toxicity in IgG4-related disease patients. <h3>Acknowledgements:</h3> I thank all the authors included in this work for their support and dedication in carrying out this research project. <h3>Disclosure of Interests:</h3> <b>None declared.</b>