Glucocorticoid withdrawal schemes in chronic medical disorders. A systematic review

This systematic review highlights the uncertainty about the safety and efficacy of glucocorticoid withdrawal in many chronic diseases, elucidating the need for further research in this area. The problem of glucocorticoid withdrawal seems to be good example for wide variation in physicians' approaches to weaning patients off glucocorticoids. This practice variation appears justified, given the well known extraordinary array of individual reactions to systemic glucocorticoid therapy [44], the obligation to individualize treatment, and scientific uncertainty. Moreover, only sparse information concerning health-related quality of life, well-being and symptoms, and socioeconomic sequelae after glucocorticoid withdrawal is available from published randomized trials. In conclusion, clinicians and patients need many more--and in a number of conditions, initial--high quality studies to assess the safety and efficacy of systemic glucocorticoid withdrawal schedules in chronic diseases.