Balancing the Therapeutic and Adverse Effects of Oral Prednisone/Prednisolone: A Systematic Review

Abstract

Prednisone and prednisolone are synthetic analogues of the natural steroid hormones produced by the adrenal cortex. They have anti-inflammatory, and immunosuppressant effects. Prednisone is biologically inert and in order to become active, it is converted to prednisolone in the liver. Both drugs have been used for treatment of uncontrollable asthma, chronic obstructive pulmonary disease, sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, ophthalmologic conditions, and several other autoimmune disorders. Despite their efficacy, therapy has been associated with a broad range of toxicities, limiting patients’ compliance. This review emphasizes measures for balancing the therapeutic and adverse effects of these drugs based on current literature and clinical evidence. Online searches were carried out in the databases of PubMed, Medline and Google Scholar for publications using terms like “prednisone,” “prednisolone,” “oral corticosteroids,” “adverse effects of prednisone/prednisolone.”  Lateral searching via related citation (PubMed), checking reference lists of identified studies and narrative synthesis of included studies were performed. Adverse effects are mostly seen in patients receiving glucocorticoids in high doses, or over a long period of time. They include adrenal suppression, fractures, weight gain, infections, fractures, hypertension, cataract, among others. Practical measures for mitigating adverse events for optimal benefit from steroid therapy include monitoring of patients for adverse effects; gradual tapering during withdrawal to prevent adrenal suppression and disease flares; prescribing of the lowest possible dose for the shortest possible period by clinicians, and consideration for once-daily dosing, morning dosing, and alternate-day dosing; evaluation of risk factors or preexisting conditions that could be aggravated by corticosteroid treatment; calcium and vitamin D supplementation, weight-bearing exercises, and use of bisphosphonates to mitigate osteoporosis. The phobia, apprehension and uncertainties associated with adverse effects of these steroids can be curtailed or avoided when appropriate measures are taken. This is particularly important in many life-threatening maladies with little or no therapeutic alternatives.