Oral glucocorticoid pulse therapy: a modest change in clinical practice with major benefits

Glucocorticoid pulse therapy is commonly prescribed by rheumatologists worldwide for a wide variety of serious and potentially life-threatening diseases. Pulse therapy also has the potential to lower the cumulative glucocorticoid burden, which has already been proven in systemic lupus erythematosus and giant cell arteritis. The standard practice in rheumatology is to administer this therapy intravenously, but current literature suggests that oral methylprednisolone is a non-inferior option for clinical outcomes and safety. Integrating oral methylprednisolone pulse therapy into rheumatological practice might have considerable benefits, not only for patients but also for society as a whole. In this Viewpoint, we provide a review of oral methylprednisolone pulse therapy covering pharmacology, safety, patient preference, sustainability, and its possible use in rheumatology practice. We aim to increase awareness among rheumatologists of the potential use of oral glucocorticoid pulse therapy as this modest change in clinical practice has major benefits.