Steroid Tapering Regimen for Chronic Granulomatous Mastitis
For chronic granulomatous mastitis, start with prednisone 0.5-1 mg/kg/day (typically 30-60 mg daily) for 2-4 weeks, then taper by 10 mg every 2 weeks until reaching 10 mg daily, followed by slower tapering of 1 mg every 4 weeks until discontinuation, with a total treatment duration of 4-6 months. 1, 2
Initial Treatment Phase
- Starting dose: 0.5-1 mg/kg/day of prednisone (typically 30-60 mg daily) 2
- Duration of initial dose: 2-4 weeks until clinical improvement is noted 1, 3
- Administration timing: Morning dosing (before 9 am) to minimize adrenal suppression 4
Tapering Schedule
First Phase (Higher Doses)
- Reduce by 10 mg every 2 weeks until reaching 10 mg daily 1
- Example for 60 mg starting dose:
- Weeks 1-2: 60 mg daily
- Weeks 3-4: 50 mg daily
- Weeks 5-6: 40 mg daily
- Weeks 7-8: 30 mg daily
- Weeks 9-10: 20 mg daily
- Weeks 11-12: 10 mg daily
Second Phase (Lower Doses)
- Once at 10 mg daily, slow the taper to 1 mg reduction every 4 weeks 5, 1
- Alternative approach: Use alternate-day dosing (e.g., 10 mg/7.5 mg on alternate days) 5, 1
- Continue tapering until complete discontinuation
Total Treatment Duration
- Complete treatment course typically spans 4-6 months 2
- Longer courses may be needed for refractory cases 3
Monitoring and Follow-up
- Follow-up every 4-8 weeks during the first year of treatment 5, 1
- Monitor for:
- Clinical response (reduction in breast inflammation, pain, and mass)
- Steroid-related side effects
- Signs of adrenal insufficiency during tapering (fatigue, weakness, dizziness)
Management of Relapse
If relapse occurs during tapering:
- Increase dose to the pre-relapse dose 5
- Maintain for 2-4 weeks until symptoms improve
- Resume tapering more gradually (within 4-8 weeks) to the dose at which relapse occurred 5
- Consider adding a steroid-sparing agent if multiple relapses occur 3
Special Considerations
- For night pain while tapering below 5 mg daily, consider split dosing rather than once-daily dosing 5, 1
- Gastric irritation may be reduced by taking prednisone with food or milk 4
- Consider calcium and vitamin D supplementation for courses exceeding 3 months 1
- Avoid abrupt withdrawal of therapy due to risk of adrenal insufficiency 4
Alternative Approaches
- For patients with significant steroid-related concerns, consider adjunctive treatment with methotrexate as a steroid-sparing agent 5, 3
- Topical steroids may be beneficial as an adjunct to oral therapy in some cases 6
- Pre-surgical steroid therapy may reduce recurrence rates compared to surgery alone 7
This regimen balances the need for effective anti-inflammatory treatment while minimizing steroid-related adverse effects through a structured, gradual tapering approach.