Comparison of daily and alternate-day prednisone during chronic maintenance therapy: a controlled crossover study

To determine if dose spacing of low dose chronic suppressive corticosteroid therapy would result in different effects on circulating T lymphocytes and hypothalamic-pituitary-adrenal (HPA) axis suppression, a crossover trial of two maintenance steroid regimens was performed. Twenty stable renal allograft recipients were treated for 6 mo with daily prednisone (DS) and then the same patients were abruptly converted to alternate-day prednisone (ADS) for another 6 mo. Total prednisone dosage was identical during the 6-mo study periods and only dose spacing differed. Both circulating T lymphocyte numbers and responsiveness to mitogens were less on the DS regimen. Patients gained weight on DS and lost weight on ADS. Five of the 20 patients developed infections on DS. However, HPA suppression was not different on the two regimens. These findings suggest that dose spacing alters the immunosuppressive and metabolic response to prednisone, even at low dose.