What are safe alternatives to corticosteroid (steroid) use?

From the Guidelines

Safe alternatives to steroid use include leukotriene modifiers, cromolyn sodium, and nedocromil, as well as long-acting beta2-agonists (LABAs) and immunomodulators like omalizumab, as recommended by the most recent guidelines 1. When considering alternatives to steroid use, it's essential to prioritize the patient's specific condition and medical history.

• For patients with mild persistent asthma, alternatives to steroids include leukotriene receptor antagonists (LTRAs) such as montelukast and zafirlukast, as well as cromolyn sodium and nedocromil 1.
• For patients with moderate to severe persistent asthma, LABAs like salmeterol and formoterol can be used in combination with inhaled corticosteroids (ICSs) to achieve better control of symptoms 1.
• Immunomodulators like omalizumab can be used as adjunctive therapy for patients with severe persistent asthma who have sensitivity to relevant allergens 1.
• Other alternatives include methylxanthines like sustained-release theophylline, which can be used as adjunctive therapy with ICSs in patients 5 years of age and older 1. It's crucial to note that these alternatives should be used under the guidance of a healthcare professional, as they may have different efficacy and safety profiles compared to steroids.
• The most recent guidelines recommend against the use of systemic corticosteroids for long-term management of atopic dermatitis, instead suggesting alternatives like mycophenolate mofetil, azathioprine, and cyclosporine for refractory moderate to severe cases 1.
• Ultimately, the choice of alternative therapy should be based on the individual patient's needs and medical history, as well as the most recent and highest-quality evidence available 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain Ibuprofen tablets cannot be expected to substitute for corticosteroids or to treat corticosteroid insufficiency.

Safe alternatives to steroid use are NSAIDs such as:

• Naproxen
• Ibuprofen These alternatives can be used to treat pain and inflammation, but they should be used under the guidance of a healthcare provider and with caution, as they can have side effects. It is also important to note that NSAIDs should not be used as a replacement for corticosteroids without consulting a healthcare provider, as abrupt discontinuation of corticosteroids can lead to disease exacerbation 2, 2, 3.

From the Research

Safe Alternatives to Steroid Use

• There are several alternatives to steroid use, particularly for patients with severe asthma, including biologic therapies such as omalizumab, mepolizumab, benralizumab, and dupilumab, which have been shown to reduce the need for oral corticosteroids (OCS) and improve patient-related outcomes 4.
• These biologic therapies have revolutionized the treatment of uncontrolled severe asthma by reducing or even eliminating the need for OCS and improving other major outcomes 4, 5.
• For patients with acute conditions, short-term systemic corticosteroids may be prescribed, but their use should be carefully considered due to potential adverse effects, and evidence supporting their use is limited for most diagnoses 6.
• Topical corticosteroids remain a common treatment option for inflammatory dermatoses, and their use can be optimized by selecting the appropriate vehicle and using them in combination with other therapeutic agents 7.

Reducing Steroid Dependence

• Biologic therapies have been shown to have an OCS-sparing effect in severe asthma, reducing the need for oral corticosteroids and improving patient-related outcomes 4, 5.
• Targeted biologic therapies can reduce or even eliminate the need for OCS in severe asthma, improving lung function, reducing exacerbations, and improving quality of life 4, 5.
• Judicious use of topical corticosteroids, including short-term application and combination with other therapeutic agents, can minimize side effects and optimize treatment outcomes 7.

Considerations for Steroid Use

• The use of oral corticosteroids is associated with several comorbidities that can decrease health-related quality of life and worsen prognosis, highlighting the need for careful consideration and monitoring 4.
• Short-term systemic corticosteroids are associated with potential adverse effects, including hyperglycemia, elevated blood pressure, mood and sleep disturbance, sepsis, fracture, and venous thromboembolism 6.
• The selection of appropriate steroid treatments and alternatives should be based on individual patient needs, disease severity, and evidence-based guidelines 4, 6, 7, 5.