Weaning patients off long-term prednisolone: a survey of physicians’ practice in the UK and Southeast Asia

TL;DR

This study surveyed UK and Southeast Asian physicians on how they wean patients off long-term prednisolone, revealing varied practices and common challenges like disease relapse.

Contribution

The study provides insights into current clinical practices and barriers to weaning glucocorticoids across different medical specialties.

Findings

Endocrine specialists often switch to hydrocortisone for weaning, while non-endocrine specialists may abruptly stop prednisolone.

Relapse of the underlying condition is the most common barrier to weaning reported by both specialist groups.

Only a minority of non-endocrine specialists refer patients to endocrinology for supervision during weaning.

Abstract

Prolonged glucocorticoid (GC) use is associated with significant morbidity and mortality, including the development of GC induced adrenal insufficiency. Recent guidance from the European Society of Endocrinology and Endocrine Society provides a framework for tapering GCs. However, there is limited understanding of current practice across endocrine and other medical specialties, including barriers and challenges to GC weaning. This study aimed to establish how GCs are weaned in patients across endocrine and non-endocrine specialists.

Anonymous online surveys were disseminated to all members of the Society for Endocrinology and all members of the Association of Southeast Asian Nations Federation of Endocrine Societies and the Endocrine and Metabolic Society of Singapore. Non-endocrine specialists were surveyed in the UK and in Singapore.

A total of 306 (258 endocrine specialists and 48 non-endocrine specialists) responded to the survey. Approaches to discontinuing prednisolone were heterogeneous. Among endocrine respondents, only 78% would fully wean the prednisolone, with 50.4% switching to hydrocortisone to wean and 12.6% favouring long-term GC replacement without further investigations. Among the non-endocrine respondents, 16.7% would stop prednisolone abruptly and 10.4% would refer to endocrinology to supervise weaning. The most common barrier to weaning GCs reported by both endocrine and non-endocrine specialists was relapse of the underlying condition (55.9% and 70.8%, respectively).

Relapse of the underlying condition is common, and endocrinology input may not be appropriate when this occurs. There remains a need to develop an evidence-based approach for safe and effective GC weaning and hypothalamic–pituitary–adrenal axis assessment.

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