Glucocorticoid Dosing and Implications for Vaccination: Evolution of Global Definitions

Area of Science:

• Immunology
• Pharmacology
• Vaccinology

Background:

• International immunisation guidelines often define "high-dose" glucocorticoids (e.g., >20 mg/day prednisone equivalent) without clear justification.
• Understanding the impact of varying glucocorticoid doses on vaccine efficacy and safety is essential for patient care.

Purpose of the Study:

• To review existing evidence on the relationship between glucocorticoid dosing and vaccine responses.
• To evaluate the safety and efficacy of vaccinations in patients receiving glucocorticoid therapy.

Main Methods:

• A narrative review of literature was conducted through academic database searches.
• Evidence regarding glucocorticoid dosage, vaccine response, and safety was identified and synthesized.

Main Results:

• Vaccine responses are maintained in individuals receiving low-dose prednisone (<7 mg/day).
• High-dose glucocorticoids (>20 mg/day) are associated with reduced antibody titres and seropositivity.
• Data on low- to medium-dose glucocorticoids (7-20 mg/day) and their impact on vaccine efficacy is inconclusive.
• Insufficient data exists to establish a unified paediatric high-dose glucocorticoid threshold due to inconsistent dosing.

Conclusions:

• Clinicians should prioritize individual risk-benefit assessments over strict dosing thresholds for immunisation in patients on glucocorticoids.
• Non-live vaccines are generally well-tolerated, but live vaccines may pose risks in severely immunocompromised individuals.