Glucocorticoid Tapering: a Literature Review

Nurul Damayanti, Sumarno Sumarno


Glucocorticoids (GCs), a class of corticosteroids that widely used a variety of diseases, associated physiological processes in the body [1,2]. It has structurally and pharmacologically similar to the endogenous hormone cortisol with various beneficial functions like anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects. As an anti-inflammatory and immunosuppressive effect, corticosteroids through a combination of both inhibition & upregulation of gene transcription [3-5]. Despite beneficial effects, they also have side effects that depend on the dose, type of steroid and length of treatments [6]. Short courses of high-dose GCs usually are safe and reasonably well-tolerated, but they do have numerous potential adverse effects [7]. Many of the severe complications occur in long-term use at doses greater than 20 mg of prednisone per day for three weeks or more causes tertiary adrenal insufficiency due to the HPA-axis (Hypothalamic Pituitary Adrenal Axis) suppression by endogenous GCs [8-10]. In this article, we’ll discuss how to manage GCs tapering and when is the right time to use GCs.

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Becker DE. Basic and clinical pharmacology of glucocorticosteroids. Anesthesia progress. 2013 Mar;60(1):25-32.

Vandevyver S, Dejager L, Tuckermann J, Libert C. New insights into the anti-inflammatory mechanisms of glucocorticoids: an emerging role for glucocorticoid-receptor-mediated transactivation. Endocrinology. 2013;154(3):993-1007.

Perretti M, D'acquisto F. Annexin A1 and glucocorticoids as effectors of the resolution of inflammation. Nature Reviews Immunology. 2009 Jan;9(1):62-70.

Girol AP, Mimura KK, Drewes CC, Bolonheis SM, Solito E, Farsky SH, Gil CD, Oliani SM. Anti-inflammatory mechanisms of the annexin A1 protein and its mimetic peptide Ac2-26 in models of ocular inflammation in vivo and in vitro. The Journal of Immunology. 2013 Jun 1;190(11):5689-701.

Chatham W. Glucocorticoid effects on the immune system. UpToDate. 2017.

Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, Brown JP, Cohen A, Kim H. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma & Clinical Immunology. 2013 Dec;9(1):30.

National Clinical Advisory Board of the National Multiple Sclerosis Society. Recommendations Regarding Corticosteroids in the Management of Multiple Sclerosis. US Neurol. 2008;4(1).

Gensler L. Glucocorticoids. The Neurohospitalist. 2012;3(2):92-97.

Crowley RK, Argese N, Tomlinson JW, Stewart PM. Central hypoadrenalism. The Journal of Clinical Endocrinology & Metabolism. 2014 Nov 1;99(11):4027-36.

Nieman LK, Kovacs WJ. Pharmacologic use of glucocorticoids. UpTo-Date 2018;19.

Katzung BG, Masters SB, Kruidering-Hall M. Pharmacology examination & board review. New York: McGraw-Hill Medical; 2019.

Overman RA, Yeh J-Y, Deal CL. Prevalence of oral glucocorticoid usage in the United States: a general population perspective. Arthritis Care Res (Hoboken) 2013;65:294-8. doi:10.1002/acr.21796.

Sarnes E, Crofford L, Watson M, Dennis G, Kan H, Bass D. Incidence and US costs of corticosteroid-associated adverse events: a systematic literature review. Clin Ther 2011;33:1413-32. doi:10.1016/j.clinthera.2011.09.009.

Stuijver DJF, Majoor CJ, van Zaane B, et al. Use of oral glucocorticoids and the risk of pulmonary embolism: a population-based case-control study. Chest 2013;143:1337-42. doi:10.1378/chest.12-1446.

Del Rincon I, Battafarano DF, Restrepo JF, Erikson JM, Escalante A. Glucocorticoid dose thresholds associated with all-cause and cardiovascular mortality in rheumatoid arthritis. Arthritis Rheumatol 2014;66:264-72. doi:10.1002/art.38210.

Johannesdottir SA, Horváth-Puhó E, Dekkers OM, et al. Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study. JAMA Intern Med 2013;173:74352. doi:10.1001/jamainternmed.2013.122.

Iliopoulou A, Abbas A, Murray R. How to manage withdrawal of glucocorticoid therapy. Prescriber. 2013 May 19;24(10):23-9.

Yasir M, Sonthalia S. Corticosteroid Adverse Effects. [Updated 2019 Oct 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:

Alves C, Robazzi T, Mendon & ccedila M. Withdrawal from glucocorticosteroid therapy: clinical practice recommendations. J. Pediatr. 2008;84(3);192-202.

Raff H, Sharma S, Nieman L. Physiological Basis for the Etiology, Diagnosis, and Treatment of Adrenal Disorders: Cushing's Syndrome, Adrenal Insufficiency, and Congenital Adrenal Hyperplasia. Comprehensive Physiology. 2014;:739-769.

Melmed S, Melmed S, Melmed S, Larsen P, Kronenberg H, Larsen P et al. Williams textbook of endocrinology. Philadelphia, PA: Elsevier; 2015.

National Institute for Health and Clinical Excellence (NICE): Clinical Knowledge Summaries: Corticosteroids - Oral. NICE; 2012.

[], Accessed January 20, 2020.

Furst DE, Saag KG. Glucocorticoid withdrawal. UpTo-Date. 2018;19.

Gupta, P and Bhatia, V. Corticosteroid Physiology and Principles of Therapy. Indian Journal of Pediatrics. 2008 October;75.

Nieman LK, Lacroix A, Martin K. Clinical manifestations of adrenal insufficiency in adults. Retrieved March. 2018.

Furst DE, Saag KG. Glucocorticoid withdrawal. UpTo-Date. 2018;19.

Furst DE, Saag KG: Determinants of glucocorticoid dosing, Up To Date 2012;2013.

Volkmann E, Rezai S, Tarp S, Woodworth T, Furst D. We Still Don’t Know How to Taper Glucocorticoids in Rheumatoid Arthritis, and We Can Do Better. The Journal of Rheumatology. 2013;40(10):1646-1649.

Dasgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B et al. BSR and BHPR Guidelines for the Management of Giant Cell Arthritis. Rheumatology (Oxford). 2010. 49(8);1594-1597.

Robinson J. The Clatterbridge Cancer Centre NHS Foundation Trust Transforming Cancer Services for Cheshire and Merseyside.

Cutolo M. Glucocorticoids and chronotherapy in rheumatoid arthritis. RMD open. 2016 Mar 1;2(1):e000203.

Cutolo M. Circadian rhythms and rheumatoid arthritis. Joint Bone Spine. 2019 May 1;86(3):327-33. doi:10.1016/j.jbspin.2018.09.003



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