Pharmacist-led steroid stewardship in inflammatory diseases: evaluating glucocorticoid use and patient outcomes

Glucocorticoids (GCs) are widely used in inflammatory diseases but are associated with significant adverse effects when used long term. Specialty pharmacists are uniquely positioned to monitor and optimize GC use through longitudinal patient management. This study aimed to characterize GC utilization and identify opportunities for pharmacist-led stewardship within a health-system specialty pharmacy.

This prospective, multi-center descriptive study implemented a pharmacist-driven GC questionnaire within CHRISTUS Specialty Pharmacy workflow. The questionnaire was incorporated into initial, and follow-up clinical assessments conducted every four to ten months. Eligible patients included those with inflammatory conditions receiving biologic or targeted synthetic disease-modifying antirheumatic drugs (DMARDs). Data collected between October 1, 2025, and January 15, 2026, were analyzed using descriptive statistics.

Among 688 patients, 17.4% reported active GC use. Mean duration of GC therapy was 112 days and was longer in patients receiving biologic DMARDs (184 days) compared to targeted synthetic DMARDs (105 days). GC use was most common in lupus (54.6%), rheumatoid arthritis (25.8%), and ulcerative colitis (25.5%). The majority of GC users had uncontrolled disease (63.9%), while minimal adverse effects were reported.

Glucocorticoid use remains prevalent among patients receiving specialty therapies, particularly in those with uncontrolled disease. These findings highlight opportunities for pharmacist-led interventions focused on GC deprescribing, monitoring, and optimization of long-term outcomes.