What does glucocorticoid (corticosteroid) therapy mean?

From the Guidelines

Glucocorticoid therapy refers to the medical use of synthetic versions of the hormone cortisol to treat various inflammatory, autoimmune, and allergic conditions, with medications such as prednisone, methylprednisolone, dexamethasone, and hydrocortisone, which can be administered orally, intravenously, topically, or by inhalation depending on the condition being treated. This treatment involves suppressing the immune system and reducing inflammation by inhibiting the production of inflammatory chemicals and preventing white blood cells from traveling to sites of inflammation. Common uses include treating asthma, rheumatoid arthritis, inflammatory bowel disease, allergic reactions, and certain skin conditions.

Key Points to Consider

• Dosing varies widely based on the condition, with short courses often used for acute conditions (like 40mg prednisone daily for 5 days for asthma exacerbations) and lower doses for chronic conditions (like 5-10mg prednisone daily for maintenance) 1.
• Side effects can be significant, especially with long-term use, including weight gain, increased blood sugar, osteoporosis, mood changes, increased infection risk, and adrenal suppression, which is why these medications are typically used at the lowest effective dose for the shortest necessary duration 1.
• The risk of glucocorticoid-induced osteoporosis (GIOP) is a significant concern, particularly with high daily and high cumulative doses, and preventive therapy should be considered for patients at risk 1.
• For patients receiving therapeutic glucocorticoids, individualized glucocorticoid supplementation may be necessary during the peri-operative period or during physiological stress, considering factors such as dose, duration, treated condition, and degree of physiological stress 1.

Management and Prevention

• The American College of Rheumatology (ACR) has guidelines for the prevention and treatment of GIOP, which include assessing fracture risk and considering therapies to prevent bone loss 1.
• The Association of Anaesthetists, the Royal College of Physicians, and the Society for Endocrinology UK have guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency, which include individualized glucocorticoid supplementation 1.
• The goal of glucocorticoid therapy is to use the lowest effective dose for the shortest necessary duration to minimize side effects and prevent long-term complications, while still achieving the desired therapeutic effect.

From the FDA Drug Label

Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli. Glucocorticoid (corticosteroid) therapy refers to the use of glucocorticoids, such as prednisone, to treat various disorders by leveraging their anti-inflammatory and immunomodulatory effects.

• The goal of glucocorticoid therapy is to reduce inflammation and suppress the immune system in conditions where it is overactive.
• This type of therapy is commonly used to treat a range of conditions, including autoimmune diseases, inflammatory disorders, and adrenal insufficiency 2, 2.

From the Research

Definition of Glucocorticoid Therapy

Glucocorticoid (corticosteroid) therapy refers to the use of glucocorticoids, a class of drugs that have strong anti-inflammatory, immunosuppressive, and disease-modifying therapeutic effects, to treat various conditions, including rheumatoid arthritis (RA) 3, 4, 5, 6, 7.

Key Aspects of Glucocorticoid Therapy

• Glucocorticoids have been used for over 65 years in the treatment of RA, with evidence showing their disease-modifying effect, especially in early RA 4.
• They are widely used in combination with other synthetic and biological disease-modifying anti-rheumatic drugs to manage RA 5.
• The use of glucocorticoids can provide rapid relief of symptoms and delay the progression of joint damage, but it is also associated with potential adverse effects, particularly with long-term use at higher doses 3, 6, 7.
• Recent guidelines recommend using glucocorticoids as bridging therapy or at low doses for prolonged periods, with a focus on balancing the benefits and risks of treatment 7.

Benefits and Risks of Glucocorticoid Therapy

• Benefits: disease-modifying effects, rapid relief of symptoms, and delay of joint damage progression 3, 4, 5, 6, 7.
• Risks: adverse effects, such as infections, and potential long-term consequences, particularly with high-dose or prolonged use 3, 6, 7.
• Recent data suggest a favorable risk-benefit balance for low-dose, prolonged glucocorticoid therapy, even in senior patients 7.