From the Guidelines
Prednisone should be tapered down to an individual level sufficient to maintain a remission from 20 mg daily onward, with reduction done by 5 mg every week until 10 mg/day are achieved and even further reduction by 2.5 mg/week considered up to 5 mg daily. This approach is based on the most recent and highest quality study available, which provides guidance on the diagnosis and management of autoimmune hepatitis 1. The tapering schedule is crucial to prevent adrenal insufficiency and minimize corticosteroid-related side effects.
When tapering prednisone, it is essential to monitor patients for signs of adrenal insufficiency, such as fatigue, weakness, dizziness, nausea, and joint pain, as well as disease flare-up. The tapering schedule should be individualized based on the underlying condition being treated, as some diseases may require more gradual reduction to prevent relapse.
Key considerations for tapering prednisone include:
- Starting tapering from 20 mg daily onward
- Reducing the dose by 5 mg every week until 10 mg/day are achieved
- Further reducing the dose by 2.5 mg/week up to 5 mg daily
- Monitoring for corticosteroid-related side effects, such as osteoporosis, brittle diabetes, and hypertension
- Considering the use of a combination regimen with azathioprine to minimize corticosteroid-related side effects, as this approach has been associated with a lower occurrence of these side effects (10% versus 44%) 1.
By following this tapering schedule and considering individual patient factors, clinicians can minimize the risks associated with prednisone use and optimize treatment outcomes for patients with autoimmune hepatitis and other conditions requiring corticosteroid therapy.
From the FDA Drug Label
If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
- Tapering of prednisone is recommended when stopping the drug after long-term therapy.
- The drug should be withdrawn gradually rather than abruptly to minimize potential withdrawal symptoms.
- The exact tapering schedule is not specified in the drug label, and the decision to taper should be made on an individual basis, taking into account the patient's disease status and response to treatment 2.
From the Research
Tapering Prednisone
- The decision to taper prednisone should be based on the individual patient's response to treatment and the underlying condition being treated 3, 4, 5, 6, 7.
- In patients with rheumatoid arthritis, continuing glucocorticoids at 5 mg per day for 24 weeks provided safe and better disease control than tapering glucocorticoids 3.
- In patients with acute exacerbations of asthma, tapering of prednisone may not be needed 5.
- In patients with myasthenia gravis, rapid tapering of prednisone appears to be feasible, well tolerated, and associated with a good outcome 6.
- In patients with systemic lupus erythematosus, prolonged doses of glucocorticoids greater than 7.5 mg/day are associated with damage accrual, and tapering schemes have not been well defined 7.
Factors to Consider When Tapering Prednisone
- Disease activity and response to treatment 3, 6.
- Dose and duration of prednisone treatment 4, 7.
- Presence of comorbidities or concomitant medications 4.
- Risk of infection or other adverse effects 4, 7.