Corticosteroids help reduce inflammation and suppress immunity, alleviating symptoms associated with conditions like rheumatoid arthritis and asthma. Unfortunately, they can also have unwanted side effects, including thinned skin, weight gain and oral thrush.
Studies have demonstrated that administering steroids on an alternate day schedule helps minimize hypothalamic-pituitary-adrenal axis suppression and increase patient compliance with therapy.
What is ADT?
Alternate Day Therapy (ADT) is a corticosteroid dosing technique developed to give long-term pharmacologic dose patients with benefits of corticosteroid treatment while simultaneously mitigating unwanted features of therapy such as pituitary-adrenal suppression, Cushing’s syndrome and withdrawal symptoms of corticoid use. ADT involves administering twice their daily dosage every other morning until symptoms subside.
Corticosteroid medicines provide relief for inflammation, pain and other symptoms caused by many conditions including rheumatoid arthritis, lupus, inflammatory bowel disease, asthma and allergies. Corticosteroids may also prevent organ rejection in transplant recipients by being taken orally as tablets, capsules or syrups; or injection into muscles and joints through inhalers and nasal sprays or used topically via creams and ointments applied directly onto skin areas.
Long-term corticosteroid usage may result in osteoporosis. Speak to your healthcare provider about taking calcium and vitamin D supplements as protection.
Dosage
Alternate Day Therapy (ADT) is the recommended approach for long-term corticosterroid usage, according to NHLBI guidelines for asthma treatment. ADT can also be beneficial in patients suffering from rheumatoid arthritis, systemic lupus erythematosus and glomerulonephritis – it has been shown to lower rates of relapses and incidence of side effects compared with daily administration – ADT being especially helpful with children experiencing frequently relapsing steroid dependent Nephrotic Syndrome and Lupus Nephritis patients; in those suffering from Rheumatoid disease alternate day therapy is linked with decreased risks of infection as well.
The alternate day regimen is founded upon two major premises: (1) that anti-inflammatory activity of steroids outlives their physical presence and metabolic effects; and (2) that gradual declines in plasma corticoids throughout the day result in less suppression of hypothalamic pituitary-adrenal axis on non-steroid days, particularly if doses are taken between 2-8 AM when adrenal cortex activity is at its highest.
Studies have demonstrated that intermittent corticosteroid therapy results in significantly less suppression of the hypothalamic-pituitary-adrenal (HPA) axis than daily corticosteroid treatment, as shown by several comparison studies between alternate day and daily corticosteroid therapies for various autoimmune diseases including rheumatoid arthritis, psoriasis and ulcerative colitis. Furthermore, those treated with prednisone on an alternate day basis experienced significantly fewer infections compared with daily treatment regimens.
However, it should be kept in mind that not all patients respond well to alternate day therapy (ADT). Some will require initial high dose daily therapy prior to changing over to ADT; these patients should be closely monitored until an acceptable clinical response has been seen and then switched over as soon as this occurs. In more serious disease states such as allergies and collagen disorders where four to ten days may be required before seeing results, daily divided high dose therapy may need to continue until an adequate response has been seen before commencing ADT therapy.
Side Effects
Long-term corticosteroid use increases your risk of serious side effects, such as infections. Therefore, regular screenings while on these drugs is important in order to detect or prevent serious adverse events from happening. Corticosteroids are medications used to relieve pain, swelling and stiffness caused by various conditions including rheumatoid arthritis; their most frequent side effect is known as edema; other symptoms may include fatigue, weight gain or changes in mood or behavior – although most of these effects should not be serious, they should still be discussed with your healthcare provider.
Corticosteroid use may increase your risk of antibiotic-resistant bacterial infections that require multiple courses of treatment with different antibiotics. Furthermore, infections could potentially be delayed with corticosteroids due to increased neutrophil counts and suppressed fever levels.
Corticosteroid doses in acute form may cause blood sugar levels to rise rapidly and hyperglycemia; diabetic patients should monitor their blood sugar regularly while on these drugs.
Studies have demonstrated that an alternate day regimen can effectively manage rheumatoid arthritis symptoms with less adverse events than conventional therapies, while being safer for children and other patients suffering from inflammation conditions. Nonetheless, cushingoid features, osteoporosis, and hypothalamic-pituitary-adrenal axis suppression remain risks with an alternate-day regime.
Precautions
Corticosteroid medicines provide effective relief for numerous diseases, such as arthritis and asthma. By suppressing inflammation and immune systems, they help manage conditions wherein natural defenses mistakenly attack tissues that don’t belong to you. When embarking on long-term steroid therapy it is crucial that one understands both risks and benefits so they can make informed decisions for themselves and their situation.
If you suffer from Addison’s disease, for example, your health care provider will likely prescribe oral or intravenous steroids as part of a daily dose to replace cortisol and aldosterone that your body no longer produces naturally. Once the underlying illness has been successfully addressed, however, these medicines will likely no longer need to be taken as frequently.
Systemic GC therapy has been linked with serious adverse effects, particularly at higher doses or over longer periods. These side effects include Cushing’s syndrome, adrenal suppression, increased susceptibility to infection, hyperglycemia, hyperlipidemia and cardiovascular disease as well as gastrointestinal disturbances, psychiatric abnormalities, osteoporosis and more.
Your health care provider will strive to minimize exposure of other parts of your body to corticosteroids when prescribing long-term steroids, for instance if you suffer from asthma inhaled steroids can reach lung surfaces directly, thus decreasing overall corticosteroid absorption by your system. Calcium and Vitamin D supplements may be recommended to protect bone density against osteoporosis.
Your doctor should carefully discuss the risks and benefits of taking steroids, and it is essential that you follow his or her instructions to the letter if taking these medications. This means taking exactly as directed, not using more than prescribed, and discontinuing treatment without notice.
As soon as your doctor prescribes long-term steroids, they’ll start you out on a low dose and gradually increase it until reaching its maximum amount. This allows for safe administration while giving your adrenal glands time to recover from suppressing their natural production of steroids. If taking oral steroid pills over an extended period, be sure to wear a medical alert bracelet so others are aware of your condition in case of emergency.
