Body mass index associated with glucocorticoid-related weight gain in children with rheumatic disease on high-dose prednisone.

OBJECTIVES

To evaluate the relationship between patient variables that affect pharmacokinetic variability with glucocorticoid (GC)-related weight gain within the first 12 months of starting prednisone therapy.

METHODS

We conducted a retrospective chart review of children aged <18 years diagnosed with rheumatic disease treated with moderate to high-dose prednisone therapy at a single Canadian paediatric academic hospital between January 1, 2010, and December 31, 2020. Using a binary logistic regression, eGFR, initial Body Mass Index (BMI), transaminitis and albumin were evaluated as predictors of GC-related obesity (defined as weight gain greater than 20% and BMI z-score ≥1.88 or >95%ile after 12 months of treatment) was evaluated.

RESULTS

Data for sixty-two patients were included in this analysis with 18 (29%) systemic JIA, (6%) other JIA subtypes, 22 (36%) SLE, and 8 (13%) JDM patients, and the remaining patients diagnosed with connective tissue disease and other inflammatory disorders (n=10, 16%). Eighteen (29%) patients met criteria for GC-induced obesity by 12 months of therapy. Greater BMI z-score prior to initiation of GC-therapy was associated with greater risk of developing GC-induced obesity (OR=2.35, 95%CI=1.39-3.96, p<0.001).

CONCLUSIONS

Greater BMI was a predictor of severe GC-related obesity for children with rheumatic disease requiring moderate to high-dose prednisone therapy. Further work is required to determine methods for individualised prednisone dosing, and interventions to mitigate risk for weight gain.