What is a faster acting corticosteroid?

From the Guidelines

For patients requiring a faster-acting corticosteroid, osilodrostat and metyrapone are the most effective options, with response typically seen within hours, as noted in the 2021 guideline update published in The Lancet Diabetes and Endocrinology 1. When considering rapid normalization of cortisol, it is crucial to prioritize medications that can achieve this goal swiftly. The following key points highlight the benefits and considerations of these faster-acting corticosteroids:

• Osilodrostat and metyrapone offer rapid response, typically within hours, making them ideal for severe disease management.
• Ketoconazole, although effective, has a slightly slower onset of action, typically within a few days.
• Etomidate is another rapid-acting option, suitable for hospitalized patients who cannot take oral medications.
• In cases of very severe hypercortisolism, combinations of steroidogenesis inhibitors may be necessary, and if optimized medical therapy is ineffective, BLA should be considered to avoid worsening outcomes, as recommended in the guideline update 1. Key characteristics of these medications, such as their onset of action, potency, and potential side effects, should be carefully considered when selecting the most appropriate treatment option.

From the Research

Faster Acting Corticosteroid

• The study 2 compared the clinical outcome and laboratory results of patients with severe Covid-19 pneumonia treated with dexamethasone versus high-dose methylprednisolone.
• The results showed that patients treated with methylprednisolone had a shorter recovery time, lower need for transfer to intensive care, and decreased severity markers such as C-reactive protein (CRP), D-dimer, and LDH.
• Another study 3 compared the efficacy and safety of two regimens of sequential systemic corticosteroids in the treatment of acute exacerbation of bronchial asthma, and found that intravenous methylprednisolone followed by oral methylprednisolone was more efficacious and safer than intravenous hydrocortisone followed by oral prednisolone.
• A review of oral corticosteroid regimens for acute asthma 4 found no convincing evidence of differences in outcomes between higher dose or longer course and lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone.
• A study 5 compared the efficacy of intravenous methylprednisolone, hydrocortisone, and dexamethasone in the treatment of acute severe pediatric asthma, and found that the three corticosteroids had equivalent efficacy when used at the appropriate doses.
• A study 6 discussed the potency of different corticosteroids, with dexamethasone being a long-acting systemic corticosteroid, 25 times more potent than short-acting products like hydrocortisone, and methylprednisolone being an intermediate-acting product, 4-5 times more potent than hydrocortisone.

Comparison of Corticosteroids

• Methylprednisolone and dexamethasone are both used to treat various medical conditions, including asthma and Covid-19 pneumonia 2, 3, 5.
• The choice of corticosteroid may depend on the specific condition being treated, as well as the patient's individual needs and medical history.
• More research is needed to fully understand the differences in efficacy and safety between different corticosteroids, particularly in the treatment of acute severe asthma and Covid-19 pneumonia 2, 4, 5.