From the Guidelines
For corticosteroid courses of less than 1 week, there is no need to taper the dose, and for slightly longer courses, such as up to 10 days, there probably is no need to taper, especially if patients are concurrently taking inhaled corticosteroids (ICSs) 1. When considering the discontinuation of a corticosteroid course, it's crucial to weigh the potential risks and benefits, particularly in the context of asthma management. The primary concern with abruptly stopping corticosteroids is the potential for adrenal insufficiency, which can lead to serious health issues. However, the evidence suggests that short courses of corticosteroids, typically those lasting less than 1 week, can be discontinued without tapering, and this approach is supported by guidelines for managing asthma exacerbations 1. Key considerations include:
- The duration of the corticosteroid course: Courses less than 1 week can usually be stopped without tapering.
- Concurrent use of inhaled corticosteroids (ICSs): Patients on ICSs may not require tapering for slightly longer corticosteroid courses, up to 10 days.
- Individual patient factors: The decision to taper or not should consider the patient's specific health status, history of corticosteroid use, and potential for adrenal insufficiency. It's essential to consult with a healthcare provider before making any changes to a corticosteroid regimen, as they can provide personalized guidance based on the patient's unique situation and medical history 1.
From the FDA Drug Label
Do not stop taking this medicine without first talking to your doctor. Avoid abrupt withdraw of therapy. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
- Abrupt discontinuation of a corticosteroid course is not recommended.
- The drug label advises against abrupt withdrawal of therapy and recommends gradual withdrawal after long-term therapy.
- Patients should consult their doctor before stopping the medication 2.
From the Research
Discontinuing Corticosteroid Course
- A corticosteroid (steroid) course should not be discontinued abruptly due to the risk of adrenal insufficiency, as evidenced by studies 3, 4, 5, 6, 7.
- Adrenal insufficiency can occur even at low doses of prednisolone, such as 5mg/day, and can persist for an extended period after glucocorticoid withdrawal 3, 7.
- The prevalence of adrenal insufficiency in patients on long-term glucocorticoid treatment is significant, ranging from 37.4% to 63% in different studies 7.
- The risk of adrenal insufficiency is associated with the dose and duration of glucocorticoid treatment, but it can occur even at low doses and short durations 7.
- A slow tapering of the glucocorticoid dose is recommended to minimize the risk of adrenal insufficiency and other withdrawal reactions 4, 5, 6.
- Patients with adrenal insufficiency may require lifelong replacement therapy with glucocorticoids, and the optimal strategy for steroid withdrawal and monitoring for adrenal insufficiency is still unclear 5, 6.
Factors Influencing Adrenal Insufficiency
- The dose of prednisolone at the time of adrenal function testing is a significant predictive risk factor for tertiary adrenal insufficiency 6.
- The duration of glucocorticoid treatment is not a significant predictor of recovery from adrenal insufficiency 6.
- Peak steroid dose is predictive of recovery from adrenal insufficiency, with lower doses associated with a higher likelihood of recovery 6.
- Age, sex, and underlying rheumatological condition are not significant predictors of adrenal insufficiency or recovery 6.