Abstract
Conference poster:
Background/Purpose: Glucocorticoids (GCs) are highly effective anti-inflammatory agents; however, treatment-related morbidity is high, with patient-reported adverse effects (AEs) occurring in 86-100% of GC users. Existing toxicity measures assess physiological effects of GC therapy but poorly capture AEs that patients consider important. Prior qualitative work by the OMERACT GC Impact Working Group indicates that patients attribute fatigue to GCs, and consider fatigue to be a significant AE. Variability in dosing regimens, treatment indication, patient ethnicity, and susceptibility to AEs is expected to influence how patients perceive GCs in different countries. We surveyed people who take GCs in Australia, Bangladesh, India, and Aotearoa New Zealand, to better understand how GCs impact patients internationally, with a particular focus on fatigue.
Methods: Cross-sectional study consisting of three surveys; a purpose-designed questionnaire on Patient's Perceptions of Glucocorticoid Therapy; the Functional Assessment of Chronic Illness Therapy-fatigue (FACIT-f) scale; and Physician Global Assessment (PGA). Paper-based questionnaires and a digital version using Research Electronic Data Capture (REDCap) were available.
Results: 236 people were surveyed (100 Bangladesh, 50 Australia, 44 India, 42 Aotearoa). As detailed in Table 1, the majority were female (81%) with younger median age in India and Bangladesh (p < 0.001); prednisolone indication differed by region, as did duration of use. Graph 1 illustrates the frequency of AEs, with weight gain (65%), change in face shape (60%), body shape (56%), and sleep disturbance (53%) reported most frequently across all countries. Regional differences were noted with AEs such as depression (p < 0.001) and osteoporosis (p < 0.001). 68 participants ranked their most severe AEs, indicating poor sleep and fatigue were worst. Complete FACIT-f data were available for 119 participants (43 India, 39 Aotearoa, 38 Australia). Multivariate regression demonstrated FACIT-f quality of life (QoL) inversely correlated with age and current prednisolone dose and positively correlated with patient agreement their disease was under control. Accounting for covariates (age, current prednisolone dose, and patient-reported disease control), there was no evidence of an independent relationship between stability of prednisolone dose (increasing, decreasing or stable) and FACIT-f QoL. Despite high rates of reported AEs, most patients (56%) felt the benefit of GCs outweighed the side effects, although uncertainty was high (29%).
Conclusions: While more work is required to determine how patients' perception of GC therapy differs between countries, this study provides a unique Asia-Pacific perspective. Despite differences in patient demographics, indication, and duration of treatment, many AEs were reported with similar frequency. FACIT-f QoL correlates independently with age, prednisolone dose, and patient-reported disease control.