[When and how to withdraw glucocorticoid therapy in elderly?]

Area of Science:

• Endocrinology
• Pharmacology
• Geriatrics

Context:

• Glucocorticoid therapy (GCT) is prevalent in managing chronic conditions, affecting approximately 3% of individuals aged 70 and older.
• Both short-term and long-term adverse effects are associated with GCT, even at low dosages.

Purpose:

• To highlight the importance of comprehensive patient assessment before initiating GCT.
• To emphasize the necessity of ongoing monitoring and dose optimization during glucocorticoid treatment.
• To discuss the non-evidence-based nature of glucocorticoid withdrawal protocols and the low risk of secondary adrenal insufficiency.

Summary:

• GCT requires pre-treatment screening for conditions that may worsen with therapy.
• Regular monitoring for side effects, dose minimization, and periodic re-evaluation of treatment necessity are essential during GCT.
• Glucocorticoid withdrawal strategies are individualized based on the risk of disease reactivation, not solely on the risk of adrenal insufficiency.

Impact:

• Informing clinicians about the critical need for proactive management of GCT to mitigate risks.
• Guiding the optimization of glucocorticoid treatment protocols in elderly populations.
• Reducing the incidence of adverse events and improving patient outcomes associated with long-term glucocorticoid use.