International Consensus Guidance for the Management of Glucocorticoid Related Complications in Neuromuscular Disease

Corey Bacher; Pushpa Narayanswami; Mark Bromberg; Frank Buttgereit; Dubravka Dodig; Eoin P Flanagan; Chloe Gottlieb; John K Marshall; Rozalina G McCoy; Sara Mitchell; Pritish K Tosh; Partha S Sinha; Ruple S Laughlin; Charles D Kassardjian

doi:10.1002/mus.28328

International Consensus Guidance for the Management of Glucocorticoid Related Complications in Neuromuscular Disease

Muscle Nerve. 2025 Jan 3. doi: 10.1002/mus.28328. Online ahead of print.

Authors

Corey Bacher¹, Pushpa Narayanswami², Mark Bromberg³, Frank Buttgereit⁴, Dubravka Dodig⁵, Eoin P Flanagan⁶, Chloe Gottlieb^{7

8}, John K Marshall⁹, Rozalina G McCoy¹⁰, Sara Mitchell^{11

12}, Pritish K Tosh¹³, Partha S Sinha¹⁴, Ruple S Laughlin¹⁵, Charles D Kassardjian^{12

16

17}

Affiliations

¹ Division of Neurology, Department of Medicine, Scarborough Health Network and University of Toronto, Toronto, Ontario, Canada.
² Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, Massachusetts, USA.
³ Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
⁴ Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
⁵ Division of Neurology, Department of Medicine, UHN/Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁹ Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹¹ Sunnybrook Health Sciences Centre, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
¹² Neurology Quality and Innovation Lab, Division of Neurology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
¹³ Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁴ Division of Endocrinology, Diabetes, and Metabolism Beth Israel Deaconess Medical Center/Harvard Medical School (P.S.S.), Boston, Massachusetts, USA.
¹⁵ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Division of Neurology, Department of Medicine, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada.
¹⁷ Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.

PMID: 39749741
DOI: 10.1002/mus.28328

Abstract

Introduction/aims: Glucocorticoid (GC)-related adverse reactions and risks are commonly seen during the treatment of immune-mediated and inflammatory neuromuscular disorders. There is wide variation in the management of associated complications. The aim of this study is to develop international consensus guidance on the management of GC-related complications in neuromuscular disorders.

Methods: Through the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), an international task force of 15 experts was convened to develop clinical guidance for the management of GC-related complications in neuromuscular patients. The RAND/UCLA appropriateness method (RAM) was used to develop consensus guidance statements. Initial guidance statements were crafted after a thorough literature review and were modified after anonymous panel input, with up to three rounds of voting via email to achieve consensus.

Results: Statements were developed and achieved consensus for general care, monitoring of patients while on GC, osteoporosis prevention, vaccinations, infection screening, and Pneumocystis jiroveci pneumonia prophylaxis. A multidisciplinary approach to the management of GC-related complications was emphasized.

Discussion: These formal consensus statements provide guidance to clinicians who use GC in the treatment of neuromuscular diseases regarding prevention and management of the more common associated adverse events and risks that arise with long and short-term GC use and serve as a springboard for investigation and updates.