Adrenocortical responsiveness after discontinuous corticosteroid therapy

Abstract

Plasma cortisol levels and the response of the adrenal gland to 0.25 mg ACTH administration were measured in 12 patients receiving 15 mg or more of a short-acting steroid (fluocortolone or prednisone) on three out of four days, in 10 patients on daily steroid treatment (15 mg prednisone or more per day), and in 9 normal subjects. The basal plasma cortisol level of the first group was between that of patients on daily prednisone treatment and that of normal subjects. The adrenal function in patients on the three out of four day treatment schedule appeared to be slightly diminished, yet still within the accepted limits for adrenals capable of responding adequately to stress. The adrenal function proved insufficient in all patients on daily steroids. The three out of four day steroid regimen thus offers a solution with many advantages over continuous steroid treatment for patients refractory to the alternate-day schedule.

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

“…A summary of these groups is presented in Table 1 , while a condensed version of the data extraction table can be seen in Supplementary File 3 . There were thirteen RCTs [19] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] with random allocation and blinding maintained throughout; the remaining 60 studies were classified as observational studies [12] , [13] , [14] , [15] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] …”

Drug combination therapy of systemic lupus erythematosus

“…Antimetabolites were replaced by CsA at a dose of 5 mg/kg l.b.w, per day, 6 days/week. Steroid medication was adjusted to the disease activity and given only 5 days/week to limit steroid-induced side effects [1]. The short-acting steroids fluocortolone and cloprednol were used since these preparations produce the least Cushingoid features and do not cause water retention.…”

New approaches to the treatment of rheumatoid arthritis

“…For this reason, it has become mandatory to drastically reduce the use of steroids either to a daily dose not exceeding the equivalent of 10 mg of prednisone or, better, to limit steroid medication to a maximum of 4 days per week with a weekly dose not exceeding 60 mg. The latter approach appears to be the least harmful, since it prevents the development of steroid dependency [2]. Recently, steroids have also been used as i. v. pulse therapy, which is certainly worth considering for severe cases of RA when trying to rapidly induce a remission.…”