What is the protocol for a short prednisone (corticosteroid) taper regimen?

From the Guidelines

The recommended protocol for a short prednisone taper regimen is to start with a dose of 0.5–1.0 mg/kg daily, with a maximum of 80 mg daily, and taper the dose over 1–2 weeks, as suggested by the Infectious Diseases Society of America 1.

Key Considerations

• The dose should be tapered gradually to avoid adrenal insufficiency, with a common approach being to reduce the dose by 10-20mg every 3-5 days.
• Patients should be monitored closely for signs of adrenal insufficiency, such as fatigue, weakness, and hypotension.
• The medication should be taken in the morning with food to minimize gastrointestinal side effects and sleep disturbances.

Important Details

• The starting dose may vary depending on the severity of the condition, with more severe cases requiring higher doses.
• Patients with diabetes should monitor their blood glucose closely, and those with hypertension should watch their blood pressure during treatment.
• Prednisone works by suppressing inflammation and immune responses, making it effective for conditions like asthma exacerbations, allergic reactions, inflammatory disorders, and autoimmune flares.

Recent Guidelines

• The 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus suggests minimizing daily dose to ≤7.5 mg/day prednisone equivalent or discontinuing glucocorticoids due to the risks of long-term therapy 1.
• High-dose intravenous methylprednisolone may be used in acute, organ-threatening disease, but this is not typically part of a short taper regimen.

From the FDA Drug Label

The initial suppressive dose level should be continued until satisfactory clinical response is obtained, usually four to ten days in the case of many allergic and collagen diseases. It is important to keep the period of initial suppressive dose as brief as possible particularly when subsequent use of alternate day therapy is intended Once control has been established, two courses are available: (a) change to alternate day therapy and then gradually reduce the amount of corticoid given every other day or (b) following control of the disease process reduce the daily dose of corticoid to the lowest effective level as rapidly as possible and then change over to an alternate day schedule.

The protocol for a short prednisone taper regimen is not explicitly stated in the provided drug labels. However, it can be inferred that:

• The initial suppressive dose should be continued for 4-10 days until a satisfactory clinical response is obtained.
• Once control is established, the dose can be reduced to the lowest effective level as rapidly as possible.
• Alternate day therapy can be considered, where the dose is given every other day and gradually reduced.
• It is recommended to individualize and tailor the therapy to each patient, and to carefully weigh the benefit-risk ratio for each patient 2, 2. Key points to consider when tapering prednisone include:
• Gradually reducing the dose to minimize adverse effects
• Monitoring the patient's response to the taper
• Being prepared to adjust the taper schedule as needed
• Considering alternate day therapy to minimize adrenal suppression.

From the Research

Protocol for Short Prednisone Taper Regimen

The protocol for a short prednisone taper regimen can vary depending on the specific condition being treated and the individual patient's response to the medication.

• According to 3, moderate-to-high dose GC therapy may be tapered rapidly to near-physiological doses while watching for features of disease reactivation.
• Once close to the physiological dose, tapering is slower and at longer intervals to allow for recovery of the HPA axis.
• 4 suggests that tapering of prednisone should be done slowly using 1 mg decrements every couple weeks to a month.
• 5 found that a rapid taper of prednisone dose from 15 to 5 mg is possible in many patients with PMR, and that a subsequent year of 5 mg/day before further tapering may result in a lower total dose of prednisone.

Tapering Regimens

Different studies have investigated various tapering regimens, including:

• A 7-day tapering course of prednisone, starting with 40 mg/day and tapering to 0 mg/day 6
• A 1-year tapering course of prednisone, starting with 15 mg/day for 3 days, 10 mg/day for 7 days, and then 5 mg/day for 1 year 5
• A short taper of 1 week compared to a long taper of 7 weeks 7

Considerations

When tapering prednisone, it is essential to consider the individual patient's response to the medication and the risk of adrenal insufficiency.

• 3 notes that HPA axis recovery takes longer if the period of suppression has been long, and that tapering should be slower over a few months to even a year in such cases.
• 6 found no difference in relapse rate or adrenal suppression between patients receiving an 8-day tapering course of prednisone and those receiving a non-tapering dose of 40 mg/day prednisone.