In Dermatology practice every now and then we deal with diseases where there is a need of long continued oral corticosteroid prescription. In some cases like autoimmune bullous diseases high dose corticosteroids are usually prescribed. When there is a control of acute episode there is a need of tapering the doses though in many cases it is impossible to withdraw the corticosteroids. Usually, I follow the rule of 20% dose decrement at an interval of 2 weeks or when there are signs of disease improvement. Do you think, what is followed by me is ideal? or Is there any better and easier option for tapering?
I allow my patients to decrease dose and extension according to their illness without a limit of days. I raise them
There is no evidence-based guidelines on how to taper oral corticosteroids. Your regime is as reasonable as any other regime based on experience. The important factor is that the steroids as tapered depending on the patient's condition and only tapered when there is some improvement. The maxiumum oral dose I normally give is 60 mg daily. My dose reductions are to 50 mg, 40 mg, then by 5 mg reductions until 10 mg, then 2.5 mg reductions. Each step is usually every 2 weeks, but it will depend on clinical response.
Ther is no standard, universally applicable answer to this question but there are two basic therapeutic principles to respect.
The 1rst is to be effective against the disease treated at the lowest dose. Usually the patient will decide that with you. In rheumatology, it is easier than in dermatology. So get advice from derm colleagues.
The 2nd is to avoid side effects. Those will be best eliminated by alternate day dosage, starting to go away at < Pred 15mg every other day (QOD). As a trick, when dosage is at 25-30 mg daily (QD), we switch to 25-30mg QOD. If tolerated, after 3-4 weeks, we decrease by 5mg QOD for another 3-4 week plateau. If patient & MD are happy, we repeat. At 5-10mg QOD, there is little significant side effects and we both can live with that if total weaning is not possible.
Best wishes!
I think immediate cesation of steroids is possible in cases of less than 2 to 3 weeks of therapy.
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