What is the role of Prednisolone (corticosteroid) in the treatment of viral myositis?

From the Guidelines

Prednisolone is generally not recommended as a first-line treatment for viral myositis, but it may be considered in severe cases under close medical supervision, with a typical regimen of 0.5-1 mg/kg/day of oral prednisolone for 5-7 days, followed by a rapid taper, as suggested by the most recent and highest quality study 1.

Key Considerations

• The primary approach for viral myositis should focus on supportive care, including rest, adequate hydration, and over-the-counter pain relievers such as acetaminophen or ibuprofen to manage symptoms.
• In most cases, viral myositis is self-limiting and resolves on its own within a few weeks.
• The decision to use corticosteroids in viral myositis should be made on a case-by-case basis, considering the severity of symptoms, the overall health of the patient, and the potential risks and benefits.

Potential Risks and Benefits

• The benefit of prednisolone in severe cases is its potent anti-inflammatory effect, which can help reduce muscle inflammation and associated symptoms.
• However, this benefit must be weighed against the risk of immunosuppression, which could potentially prolong the viral infection or lead to secondary bacterial infections.

Monitoring and Follow-up

• If prednisolone is used, close monitoring for signs of worsening infection or other complications is essential.
• Other interventions, such as physical therapy, gentle stretching exercises, and ensuring adequate nutrition and hydration, should be tried before considering prednisolone.

Evidence Summary

• The most recent and highest quality study 1 suggests that prednisolone may be considered in severe cases of viral myositis, with a typical regimen of 0.5-1 mg/kg/day of oral prednisolone for 5-7 days, followed by a rapid taper.
• Other studies 2, 3, 4, 5, 6, 7, 8 provide additional guidance on the management of myositis, but the most recent and highest quality study 1 takes precedence in guiding treatment decisions.

From the FDA Drug Label

Infections (General) Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. There may be decreased resistance and inability to localize infection when corticosteroids are used Infection with any pathogen including viral, bacterial, fungal, protozoan or helminthic infection, in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents that affect humoral or cellular immunity, or neutrophil function Infections (Viral) Chickenpox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids

The role of Prednisolone (corticosteroid) in the treatment of viral myositis is not directly supported by the provided drug labels. The labels discuss the potential for increased susceptibility to infections, including viral infections, in patients taking corticosteroids, but do not provide information on the use of prednisolone in the treatment of viral myositis specifically 9.

From the Research

Role of Prednisolone in Treating Viral Myositis

• Prednisolone, a corticosteroid, is considered a first-line treatment for inflammatory myopathies, including dermatomyositis and polymyositis 10, 11, 12.
• High-dose prednisone, often combined with another immunosuppressive agent like azathioprine or methotrexate, is commonly used to treat myositis 10, 12.
• The use of prednisolone in treating inclusion body myositis is less clear, but a trial of oral prednisone combined with methotrexate may be advised in certain cases 10, 13.
• Corticosteroids like prednisolone have anti-inflammatory and immunosuppressive effects, making them effective in reducing disease activity in myositis 11.
• However, prolonged administration of high-dose corticosteroids should be avoided due to potential side effects, and second-line agents should be introduced earlier in treatment 13.

Considerations for Prednisolone Treatment

• Patients with certain conditions, such as hepatitis C virus (HCV) infection, may require monitoring of liver enzymes and viral load when receiving prednisolone therapy 14.
• Combining prednisolone with other immunosuppressive agents or biologic agents may be necessary in severe or refractory cases of myositis 11, 12.
• Individualized and supervised exercise can be recommended in combination with pharmacological treatment, including prednisolone, to reduce disease activity and improve muscle performance 12.