Patients taking moderate daily doses of short acting corticosteroids for an extended period may switch to alternate day therapy with minimal side effects and no loss in control. Alternate day therapy entails taking either methylprednisolone or prednisone once every other morning at about twice the usual dosage.
Corticoid Dose
Alternate Day Therapy offers those requiring long term pharmacologic dose treatment the benefits of corticosteroid therapy while mitigating certain undesirable side effects, such as pituitary-adrenal suppression, Cushingoid state, and growth suppression in children. This form of therapy involves giving twice the usual daily dosage every alternate morning; dosage will depend on patient weight and size and should be determined by a medical provider.
Some short-acting corticoid agents such as methylprednisolone, hydrocortisone and prednisone are considered short-acting (producing adrenal cortical suppression for 1 1/4 to 1 1/2 days following one dose), making them suitable for alternate day therapy scheduling. If patients have been taking suppressive doses for long periods of time it may be difficult to switch over; in such instances it may be necessary either: a) providing a trial of alternate day therapy and once control has been achieved b) decreasing daily maintenance dose until daily maintenance dose reached minimum effective level before switching over onto alternate day therapy schedule.
Adverse Effects
Alternate-day therapy was shown to significantly reduce GC-related adverse effects and serum autoantibodies levels, increasing patient compliance to treatment. When compared with consecutive day treatments, patients treated on alternate days experienced less serious infections like herpes zoster, with diarrhea, nausea and stomach pain occurring less often among this group of patients.
One study randomly assigned patients suffering from flares associated with IgG4 disease to either consecutive-day or alternate day corticosteroid treatment regimens, and showed that their flare-free survival was greater for alternate-day treatments due to reduced incidences of vomiting and diarrhea as well as the use of immunosuppressants concurrently; ultimately leading to alternate day corticosteroid therapy as an ideal approach to treat adult IgG4-RD cases. The authors concluded that alternate day GC therapy is an ideal treatment approach for adult IgG4-RD patients in adults.
