title: Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis.
abstract: OBJECTIVE
  To develop a Glucocorticoid Toxicity Index (GTI) to assess glucocorticoid (GC)-related morbidity and GC-sparing ability of other therapies.
  
  
  METHODS
  Nineteen experts on GC use and outcome measures from 11 subspecialties participated. Ten experts were from the USA; nine from Canada, Europe or Australia. Group consensus methods and multicriteria decision analysis (MCDA) were used. A Composite GTI and Specific List comprise the overall GTI. The Composite GTI reflects toxicity likely to change during a clinical trial. The Composite GTI toxicities occur commonly, vary with GC exposure, and are weighted and scored. Relative weights for items in the Composite GTI were derived by group consensus and MCDA. The Specific List is designed to capture GC toxicity not included in the Composite GTI. The Composite GTI was evaluated by application to paper cases by the investigators and an external group of 17 subspecialists.
  
  
  RESULTS
  Thirty-one toxicity items were included in the Composite GTI and 23 in the Specific List. Composite GTI evaluation showed high inter-rater agreement (investigators κ 0.88, external raters κ 0.90). To assess the degree to which the Composite GTI corresponds to expert clinical judgement, participants ranked 15 cases by clinical judgement in order of highest to lowest GC toxicity. Expert rankings were then compared with case ranking by the Composite GTI, yielding excellent agreement (investigators weighted κ 0.87, external raters weighted κ 0.77).
  
  
  CONCLUSIONS
  We describe the development and initial evaluation of a comprehensive instrument for the assessment of GC toxicity.
authors.affiliation: Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Eli M
authors.initials: EM
authors.lastname: Miloslavsky
authors.affiliation: Maternal-Fetal Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Ray P
authors.initials: RP
authors.lastname: Naden
authors.affiliation: Department of Rheumatology, UMCUtrecht, Utrecht, Netherlands.
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.affiliation: Institute of Child Health, University College London, UCL Inst of Child Health, London, UK.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Brogan
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
authors.forename: E Sherwood
authors.initials: ES
authors.lastname: Brown
authors.affiliation: Late Stage Immunology Product Development, Genentech, Inc., South San Francisco, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Brunetta
authors.affiliation: Department of Rheumatology and Immunology, Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Buttgereit
authors.affiliation: Department of Rheumatology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Pinnacle, Inc., Montreal, Quebec, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: DiCaire
authors.affiliation: University of California-San Francisco, San Francisco, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gelfand
authors.affiliation: Queen's University of Belfast, Belfast, UK.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Heaney
authors.affiliation: Section of Renal Medicine and Vascular Inflammation, Division of Immunology and Inflammation, Department of Medicine, Imperial College London, Imperial College London, London, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Lightstone
authors.affiliation: Department of Rheumatology, Massachusetts General Hospital, Boston, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Dedee F
authors.initials: DF
authors.lastname: Murrell
authors.affiliation: Department of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.affiliation: Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: UAB Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Saag
authors.affiliation: Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, Canada.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
authors.affiliation: Oregon Health Sciences University, Portland, Oregon, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Winthrop
authors.affiliation: Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Rheumatology Clinic, Boston, Massachusetts, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Stone
mesh_terms: D032921:Consensus; D003661:Decision Support Techniques; D003880:Dermatology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D055552:Infectious Disease Medicine; D033183:Interdisciplinary Communication; D009398:Nephrology; D009462:Neurology; D015588:Observer Variation; D009885:Ophthalmology; D010372:Pediatrics; D011570:Psychiatry; D015272:Pulmonary Medicine; D015203:Reproducibility of Results; D012219:Rheumatology; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids
keywords: Corticosteroids; Outcomes research; Treatment