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LOW-DOSE PREDNISONE AND ADRENAL SUPPRESSION.

High-dose prednisone suppresses the hypothalamic- pituitary-adrenal (HPA) axis, but does low-dose, long-term therapy have similar effects? An analysis of 44 patients at a university-based rheumatology clinic addressed this controversy.

Patients had been taking an average of about 10 mg or less of prednisone daily during the 7 months before the study, and were taking 1.5 to 10 mg daily at the time of the study. Researchers reviewed patient charts to determine the average dose during the past 24 months, the highest daily dose, the total cumulative dose, and the total duration of therapy. They then compared the 11 patients with HPA suppression (as determined on a rapid ACTH stimulation test) to those with normal or intermediate ACTH responses.

Current steroid dose was the only significant predictor of axis function: no patient receiving less than 5 mg of prednisone daily had HPA suppression, although 3 had intermediate responses. Regression analysis showed that the rate of dose tapering did not influence recovery of the HPA axis.

Comment: These findings suggest that patients taking chronic low-dose prednisone who are tapered to less than 5 mg daily have spontaneous recovery of their HPA axis function.

— JCP

Published in Journal Watch General Medicine October 19, 1993

Citation(s):

LaRochelle GE, Jr et al. Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. Am J Med 1993 Sep 95 258-264.

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