Safely Withdrawing Glucocorticoid Therapy: A Case-Based Approach

Abstract Glucocorticoids (GCs) have potent anti-inflammatory and immunomodulating effects, making them effective for treating various diseases. They are among the most commonly prescribed medications worldwide. The prevalence of GC therapy in the general population is estimated to be ∼0.9 to 3%, though it is challenging to determine precisely. The chronic GC therapy is associated with severe morbidity and increased mortality due to iatrogenic Cushing's syndrome and suppression of the hypothalamic–pituitary–adrenal axis, leading to tertiary adrenal insufficiency. Therefore, it is not recommended to abruptly stop chronic GC therapy, and a gradual tapering of GCs is generally considered the ideal approach for GCs withdrawal. However, withdrawing GCs in patients on chronic therapy can be challenging due to the difficulty in accurately assessing HPA function. In this article, we aim to provide a practical, case-based approach to GC withdrawal based on current literature and our extensive experience in this field.