Steroid treatment may be recommended in treating various autoimmune diseases due to its ability to decrease autoantibodies levels; however, such drugs could result in side effects which lower quality of life.
Studies on 106 patients suffering from three distinct autoimmune connective tissue diseases – systemic lupus erythematosus, Sjogren syndrome and Hashimoto’s thyroiditis – demonstrated that alternate day steroid therapy achieved significant decreases in their serum autoantibodies levels.
Safety
Corticosteroid therapy is often utilized as part of treatment plans for autoimmune diseases like systemic lupus erythematosus (SLE), Sjogren’s syndrome (SS) and Hashimoto’s thyroiditis (HT). Recent evidence suggests that an alternate day scheme for administering corticosteroids reduces adverse side effects when compared to daily administration; however, less research has been published regarding whether this impact has any influence on autoantibodies that indicate autoimmunity directly.
At our center, we conducted an analysis on patients treated with alternate day steroid therapy and in whom anti-dsDNA and anti-SS-R antibodies were measured; this was both retrospective and cross-sectional analysis. The study group consisted of 106 SLE, SS, and HT patients who received low dose prednisone or deflazacort for three months prior to being assessed for anti-dsDNA and anti-SS-R antibody titers compared to results before starting therapy.
Results demonstrated a substantial decline in anti-dsDNA and anti-SS-R levels among patients treated with alternate day steroid therapy compared to control group, even though clinical activity of autoimmune diseases did not correlate directly with autoantibodies levels. Thus, comparative studies of alternate day steroid therapy with daily regimen are important to establish its safety and efficacy as well as support current recommendations that glucocorticoids be administered in short cycles to reduce suppression of the hypothalamic-pituitary-adrenal axis as well as improve quality of life among patients living with autoimmune conditions.
Efficacy
Studies have demonstrated that corticosteroid medication used in short cycles is effective at managing autoimmune disease while avoiding side effects associated with suppression of the hypothalamus-pituitary-adrenal axis, leading to improved quality of life for those suffering from autoimmune illnesses.
Autoimmune diseases are characterized by an activation of T lymphocytes which produce antibodies against antigens in our own bodies, leading to organ damage and loss of function. The main treatment used for autoimmune conditions are glucocorticoids (GCs), although their prolonged use can produce numerous side effects, especially those related to long-term use cycles.
Current recommendations for using GCs is for short cycles to avoid toxicity; however, some patients require long-term therapy to achieve remission or avoid recurrence of disease. To decrease risks of adverse effects and reduce risks of potential side effects associated with long-term therapy regimens, some physicians suggest rotating between different immunosuppressant agents (ISs).
At our descriptive, retrospective and cross-sectional study involving 106 patients diagnosed with three autoimmune connective tissue diseases – systemic lupus erythematosus (SLE), Sjogren syndrome and Hashimoto’s thyroiditis (Hashi) who received three months of alternate day steroid therapy; our researchers observed a statistically significant reduction in serum autoantibody levels at both diagnosis and three months post-initiation, regardless of gender or type of steroid medication prescribed; we observed statistically significant decreases regardless of gender or type administered steroid medication; statistically significant decreases were seen both among systemic LUS patients as well as those suffering from Hashimoto’s thyroiditis; our researchers observed statistically significant decreases.
Hunder and colleagues conducted a three-month alternate-day treatment study, wherein the mean daily prednisone dose was significantly less than in the group receiving 90-mg daily therapy, while serious infections did not significantly differ between groups. This evidence supports their hypothesis that low-dose alternate day regimen can be as effective in initial therapy of giant cell arteritis; further evaluation will need to take place in order to see whether this treatment strategy may also apply to other autoimmune diseases – for this, conducting randomized controlled trials would be optimal.
Side Effects
Studies have demonstrated that alternate day steroid therapy significantly lessens adverse side effects compared to daily dose treatment, making this an invaluable asset in terms of long-term use without suppressing pituitary-hypothalamus-adrenal axis activity and producing more sustained reduction in serum autoantibody levels.
Serum autoantibody measurements provide objective evidence of autoimmune pathologies and are thus crucial in diagnosing and assessing therapeutic responses. The aim of this study was to examine how alternate-day steroid treatment affected autoantibodies levels among those suffering from three ICD-10-coded diseases: systemic lupus erythematosus (SLE), Sjogren’s syndrome (SS), and Hashimoto thyroiditis (HT).
An innovative descriptive, retrospective, and cross-sectional study was conducted, enrolling 106 patients who were prescribed prednisone or deflazacort for at least three months and evaluated in Mexico City at the Clinical Immunology and Allergy Service at National Medical Center 20 de Noviembre 20 de Noviembre (ISSSTE), Mexico City; serum autoantibody levels were determined both before and after alternate-day steroid treatments – these results demonstrated that alternate day steroid treatment significantly decreased serum autoantibody levels regardless of disease, gender, age or type of steroids used.
Overdose
Numerous studies have demonstrated the superior effectiveness of alternate day steroid therapy over daily administration for managing giant cell arteritis. Hunder et al demonstrated this effect by showing alternate-day nonresponders still received benefits even when taking their dose on alternate days; additionally, this method significantly reduces potential overdose risks compared with daily administration; emotional disturbance has not been more frequent when given alternate day therapy than with traditional daily administration.
