What is the purpose of corticosteroids?

Purpose of Corticosteroids

Corticosteroids are potent anti-inflammatory and immunosuppressive agents that reduce inflammation by suppressing multiple inflammatory pathways, making them essential medications for treating various inflammatory, autoimmune, and allergic conditions. 1

Anti-inflammatory Mechanisms

• Corticosteroids work primarily by binding to glucocorticoid receptors in the cytoplasm, which then dimerize and translocate to the nucleus where they affect gene expression 2
• They suppress inflammation through several key mechanisms:
  • Inhibition of inflammatory gene expression by interfering with transcription factors such as nuclear factor-κB and activator protein-1 1, 3
  • Reduction of inflammatory cell migration and activation 1
  • Blocking of late-phase allergic reactions 1
  • Decreasing vascular permeability and reducing inflammatory edema 1
  • Inhibiting the release and formation of inflammatory mediators including histamine, leukotrienes, and prostaglandins 1

Clinical Applications

Respiratory Conditions

• First-line therapy for persistent asthma at all steps of care, reducing airway hyperresponsiveness and controlling symptoms 1
• Treatment of severe COVID-19 infection to suppress cytokine storm and inflammatory lung injury 1
• Management of croup to reduce airway inflammation and decrease hospitalization rates 4

Rheumatologic and Autoimmune Disorders

• Standard component of treatment for rheumatoid arthritis and other inflammatory arthritides 1
• Used at the lowest effective dose to minimize cardiovascular and metabolic side effects 1

Transplant Medicine

• Essential component of induction, maintenance, and antirejection therapy in heart transplantation 1
• Treatment of antibody-mediated rejection (AMR) in organ transplantation 1

Hematology/Oncology

• Management of cytokine release syndrome (CRS) following CAR T-cell therapy 1
• For CRS, dexamethasone is preferred for neurologic symptoms due to better blood-brain barrier penetration 1

Gastrointestinal Disorders

• Treatment of eosinophilic esophagitis (EE), with both systemic and topical (swallowed) formulations showing efficacy 1
• Topical steroids (swallowed from metered dose inhalers) provide targeted therapy with fewer systemic effects 1

Administration Considerations

• Oral corticosteroids should be taken in the morning (before 9 am) to align with the body's natural cortisol rhythm 5
• Taking with food or milk can reduce gastric irritation 5
• Alternate-day therapy may be used for long-term treatment to minimize adverse effects while maintaining therapeutic benefits 5

Important Precautions

• Corticosteroids suppress the immune system and increase infection risk with any pathogen 5
• They can reactivate latent infections such as tuberculosis and hepatitis B 5
• Abrupt withdrawal should be avoided; gradual tapering is necessary to prevent adrenal insufficiency 5
• Long-term use is associated with significant side effects including osteoporosis, hyperglycemia, hypertension, and increased cardiovascular risk 6

Specific Formulations and Potency

• Short-acting: Hydrocortisone (least potent) 4
• Intermediate-acting: Prednisone and methylprednisolone (4-5 times more potent than hydrocortisone) 4
• Long-acting: Dexamethasone (approximately 25 times more potent than short-acting products) 4

Dosing Considerations

• Dosage requirements vary significantly based on the disease being treated and patient response 5
• Initial dosage may range from 5 mg to 60 mg per day of prednisone, depending on disease severity 5
• For severe conditions like multiple sclerosis exacerbations, higher doses (equivalent to 200 mg prednisolone daily for a week) may be needed 5

Corticosteroids remain one of the most effective and widely used medications for controlling inflammation, but their use must be carefully balanced against potential adverse effects, particularly with long-term administration.