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Assessing glucocorticoid toxicity: Are the measures sensitive enough?

Robson, Joanna C; Dawson, Jill; Ndosi, Mwidimi


Jo Robson
Consultant Associate Professor in Rheumatology

Jill Dawson

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Dr Mwidimi Ndosi
Associate Professor in Nursing Rheumatology


The Glucocorticoid Toxicity Index (GTI) is a composite instrument designed to capture change in glucocorticoid-related morbidity over time.1 It was developed through consensus methods and multi-
criteria decisions among 19 medical specialists, with relative domain weights decided via clinician consensus.2 The GTI has now been used in more than 45 studies, including 12 phase 3 clinical trials.1
The GTI comprises eight domains: body mass index, blood pressure, glucose tolerance, lipid metabolism, glucocorticoid myopathy, skin toxicity, neuropsychiatric effects and infections. Two overall scores are calculated: the cumulative worsening score (CWS), which includes transient and permanent GC toxicity from baseline to specific time points, and the Aggregate Improvement Score (AIS), which accounts for improvement as well as worsening GC-toxicity.1 In The Lancet Rheumatology, Naomi Patel and colleagues3 present an analysis of domain scores of the GTI using data from the phase 3 ADVOCATE trial.4 In a clinical trial context where the GTI is used to produce repeated measures to demonstrate differences between (and within) groups of patients taking different dosages of glucocorticoids, and to measure the impact of steroid sparing agents, it is expected to have a high level of measurement validity and reliability.


Robson, J. C., Dawson, J., & Ndosi, M. (2023). Assessing glucocorticoid toxicity: Are the measures sensitive enough?. The Lancet Rheumatology, 5(3), e113-e114.

Journal Article Type Commentary
Acceptance Date Feb 3, 2023
Online Publication Date Feb 20, 2023
Publication Date Mar 1, 2023
Deposit Date Feb 22, 2023
Publicly Available Date Feb 22, 2023
Journal The Lancet Rheumatology
Print ISSN 2665-9913
Electronic ISSN 2665-9913
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 5
Issue 3
Pages e113-e114
Public URL
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Assessing glucocorticoid toxicity: are the measures sensitive enough? (166 Kb)


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Copyright Statement
This is the authors accepted version of the article ‘Robson, J. C., Dawson, J., & Ndosi, M. (2023). Assessing glucocorticoid toxicity: Are the measures sensitive enough?. The Lancet Rheumatology, 5(3), e113-e114’. DOI:<br /> <br /> The final published version is available here:<br /> <br /> © 2023 Elsevier Ltd. All rights reserved.

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