Corticosteroids have long been used to treat rheumatic illnesses, but the side effects associated with long-term regimens cause doctors to dispute over the best tapering tactics. The goal of this systematic analysis was to compare the clinical effects of various tapering regimes following corticosteroid monotherapy in individuals with rheumatic diseases. Randomized controlled trials, case-control studies, and prospective observational studies that compared at least two tapering regimens for medium- to high-dose, extended-duration corticosteroids and reported at least one efficacy and one adverse effect parameter were considered. Two trials, involving 62 patients, satisfied the review’s criteria. One research compared a prednisolone taper to a modified release prednisone taper for giant cell arteritis and found that after 26 weeks, the rates of remission were 80 percent and 85.7 percent, respectively. The other trial compared a methylprednisolone taper to a prednisone taper for polymyalgia rheumatica and found that after 26 weeks, the remission rates were 100% and 89 percent, respectively. Sleep deprivation, hyperglycemia, infection, and fractures were among the side effects documented in both studies. The trials, however, were not powered to find differences in these outcomes.
Because existing recommendations rely mainly on expert opinion and tiny case series with a trial-and-error approach, there is no high-level data to guide tapering until cessation during lengthy courses of medium- to high-dose treatment regimens. This study backs up the need for greater research to move tapering guidelines to a more evidence-based strategy.