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Development of a Web Tool to Calculate the Cumulative Dose of Glucocorticoids


 Glucocorticoids are associated with many serious side effects, most of which are related to dosing and time of use. Correct assessment of cumulative dose, especially in patients undergoing long-term treatment, is essential to determine the risk of undesirable glucocorticoid-related events. Unfortunately, there is no standard method currently available for determining exposure to glucocorticoids in daily clinical practice. The aim of this work was to create an easy-to-use free-access web application to help clinicians and researchers calculate, in a systematic way, the cumulative dose of corticosteroids in their patients. The total cumulative dose is calculated as the sum of all periods of treatment with different doses of oral or intravenous corticosteroids, and is expressed as the equivalent dose of prednisone in mg. The doses of glucocorticoids during the periods without information are estimated by first determining the average doses between the previous and subsequent periods for which such information is available, and then multiplying that average dose by the number of days of the period. If the day on which glucocorticoids were discontinued is unknown, it is assumed to be the day before the start of the next known treatment period. For unknown start dates, the day after the end of the known prior period is used. In conclusion, this tool simplifies and, through the systematic application of assumptions when information is incomplete, standardizes the glucocorticoids cumulative dose calculation, minimizing bias in the assessment of glucocorticoid-related side effects in the context of daily clinical practice.