What is prednisone (corticosteroid)?

From the Guidelines

Prednisone is a synthetic corticosteroid medication that plays a crucial role in reducing inflammation and suppressing immune system activity in various conditions, including adult onset Still's disease, with most patients requiring treatment with corticosteroids at some point in their disease course.

Key Points

• Prednisone works by mimicking the effects of cortisol, a natural hormone produced by the adrenal glands, and is used to treat a wide variety of conditions including asthma, allergic reactions, rheumatoid arthritis, lupus, inflammatory bowel disease, certain skin conditions, and some types of cancer 1.
• Typical dosing varies widely depending on the condition being treated, ranging from 5mg to 60mg daily, with treatment durations that can be as short as a few days for acute conditions or continue for months or years for chronic diseases 1.
• The recommended dosage of prednisone is 1 mg/kg (a maximum dose of 80 mg) or at an alternate-day dose of 2 mg/kg (maximum 120 mg), as suggested by the KDIGO practice guideline on glomerulonephritis 1.
• Prednisone should be taken exactly as prescribed, usually with food to minimize stomach irritation, and it's essential to never stop taking prednisone suddenly, as the body becomes dependent on it and needs to be gradually weaned off to allow the adrenal glands to resume normal function.
• Common side effects include increased appetite, weight gain, fluid retention, mood changes, elevated blood sugar, and increased susceptibility to infections, while long-term use can lead to more serious effects like osteoporosis, cataracts, and adrenal suppression 1.

Clinical Considerations

• The use of prednisone in adult onset Still's disease has been demonstrated to be effective in controlling disease in most patients, with responses ranging from 76% to 95% 1.
• Most patients with AOSD will need treatment with corticosteroids at some point in their disease course, with prednisone being a commonly used medication for this condition 1.
• The efficacy of glucocorticoids, including prednisone, has been demonstrated in several studies, with one study showing that 16/21 (76%) patients responded favorably to glucocorticoids administered for the control of systemic and joint disease 1.

From the FDA Drug Label

PredniSONE Tablets contain prednisone which is a glucocorticoid. Glucocorticoids are adrenocortical steroids, both naturally occurring and synthetic, which are readily absorbed from the gastrointestinal tract. The chemical name for prednisone is pregna-1,4-diene-3,11,20-trione monohydrate,17,21-dihydroxy-.

Prednisone is a corticosteroid, specifically a glucocorticoid, which is a type of adrenocortical steroid. It is available in oral form as PredniSONE Tablets. 2 2

From the Research

Definition and Mechanism of Action

• Prednisone is a corticosteroid, a class of drugs that are potent anti-inflammatory and immunosuppressive agents 3, 4.
• Corticosteroids, such as prednisone, work by repressing the genomic expression of proinflammatory proteins, including COX-2, IL-1, IL-2, IL-6, TNFalpha, and adhesion molecules 3.
• They achieve this by binding to glucocorticoid receptors, which then recruit histone deacetylase-2 (HDAC2) to reverse histone acetylation of activated inflammatory genes, thereby suppressing inflammation 4.

Clinical Use

• Prednisone is widely used to treat various inflammatory conditions, including rheumatoid arthritis (RA) 3, 5, asthma 4, and chronic obstructive pulmonary disease (COPD) 6, 7.
• In RA, low-dose prednisone (e.g., 10 mg daily or 5 mg bid) has been shown to control inflammatory features and retard bony damage 3.
• In COPD, prednisone is often used to treat acute exacerbations, with recent guidelines recommending a dose of 40 mg (or equivalent) for 5 days 7.

Efficacy and Safety

• Low-dose prednisone has been found to be effective in reducing inflammation and improving symptoms in RA and COPD, with minimal side effects 3, 5.
• However, high-dose or long-term use of prednisone can lead to adverse effects, such as osteopenia, stomach ulceration, and bleeding 3.
• The efficacy and safety of prednisone can be optimized by using low-dose regimens, monitoring bone status, and concomitantly administering calcium and vitamin D 3.