What is the dosing regimen for a prednisone (corticosteroid) taper in the treatment of a psoriasis flare-up?

From the Guidelines

A typical prednisone taper for a psoriasis flare-up should start with 0.5–1.0 mg/kg daily, with a maximum of 80 mg daily, in tapering doses over 1–2 weeks, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The dosing regimen should be individualized based on the severity of the flare and the patient's body weight, medical history, and previous response to steroids.
• While taking prednisone, patients should take it in the morning with food to minimize gastrointestinal side effects and sleep disturbances.
• It's essential to complete the full taper rather than stopping abruptly to avoid adrenal insufficiency.
• Prednisone works by suppressing the immune system and reducing inflammation, which helps control the excessive skin cell production and inflammation characteristic of psoriasis.

Important Notes

• Systemic steroids are generally considered a short-term intervention for severe flares rather than a long-term treatment option due to potential side effects with prolonged use, including increased risk of infection, hypertension, hyperglycemia, mood changes, and bone loss.
• The evidence from studies on biologic dose tapering in psoriasis patients 1 is not directly applicable to prednisone tapering, but it highlights the importance of individualized treatment approaches and careful monitoring of disease activity and patient outcomes.

Recommendations

• The prednisone taper should be tailored to the individual patient's needs, with close monitoring of disease activity and potential side effects.
• Patients should be educated on the importance of completing the full taper and the potential risks of abrupt discontinuation.
• Healthcare providers should consider the patient's medical history, previous response to steroids, and current disease activity when determining the optimal prednisone taper regimen.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. The dosing regimen for a prednisone taper in the treatment of a psoriasis flare-up is to gradually withdraw the drug, decreasing the initial dosage in small increments at appropriate time intervals until the lowest dosage that maintains an adequate clinical response is reached 2.

• The exact tapering schedule is not specified and must be individualized based on the patient's response and clinical status.
• Gradual withdrawal is recommended to avoid abrupt withdrawal symptoms.

From the Research

Dosing Regimen for Prednisone in Psoriasis Treatment

• The dosing regimen for prednisone (corticosteroid) taper in the treatment of a psoriasis flare-up is not directly addressed in most of the provided studies 3, 4, 5, 6.
• However, one study mentions the use of oral prednisone 40 milligrams (mg) in the treatment of erythrodermic psoriasis, followed by an extended steroid taper to alleviate the psoriatic rash 4.
• Another study discusses the use of low-dose prednisone in the management of rheumatoid arthritis, suggesting that tapering of prednisone should be done slowly using 1 mg decrements every couple of weeks to a month 7.
• It is essential to note that the dosing regimen for prednisone may vary depending on the specific condition being treated and the patient's response to the medication.
• The provided studies do not offer a standardized dosing regimen for prednisone in the treatment of psoriasis flare-ups, and further research may be necessary to determine the most effective and safe dosing strategy 3, 4, 5, 6, 7.