Weaning patients off long-term prednisolone: a survey of general physicians

Katharine Lazarus; Pei Eng; Kavita Narula; Sirazum Choudhury; Deborah Papadopoulou; Tricia Tan; Karim Meeran

doi:10.1530/endoabs.109.P32

P32

Prev Next

Section Contents Cite

Endocrine Abstracts (2025) 109 P32 | DOI: 10.1530/endoabs.109.P32

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

Weaning patients off long-term prednisolone: a survey of general physicians’ practice

Katharine Lazarus ^1,2 , Pei Eng ³ , Kavita Narula ^2,1 , Sirazum Choudhury ^1,2,4 , Deborah Papadopoulou ² , Tricia Tan ^1,2,4 & Karim Meeran ^1,2

Author affiliations

¹Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom; ²Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom; ³Department of Endocrinology, National University Health Systems, Singapore, Queenstown, Singapore; ⁴Department of Clinical Biochemistry, Northwest London Pathology, London, United Kingdom

Background: Prolonged glucocorticoid (GC) use is associated with significant morbidity and mortality, including the development of glucocorticoid-induced adrenal insufficiency (GI-AI). Recent NICE guidelines recommend a slow taper if patients are treated with GC for longer than 12 weeks. However, there is limited understanding into current practice across different medical specialties and the barriers to GC weaning.

Aim: To establish how GCs are weaned in patients across medical specialties.

Methods: An anonymous online survey was disseminated to internal medicine physicians at Imperial College Healthcare NHS Trust and the National University Hospital in Singapore between May - July 2024.

Results: Respondents were asked about their management of a patient no longer requiring 10 mg prednisolone for their underlying condition. Forty-eight responded to the survey from a broad range of medical specialties: 11.6% Rheumatology, 9.3% Respiratory, 11.6% Dermatology, 16.3% Gastroenterology, 20.9% Neurology, 4.6% Haematology, 2.3% Nephrology and 23.3% Acute Medicine. Approaches to discontinuing prednisolone were heterogeneous. 16.7% of respondents would stop prednisolone abruptly. In contrast, 47.9% said they would wean slowly (e.g. 1 mg per month) compared with 35.4% who said they would taper more rapidly (e.g. 1 mg over two weeks). 10.4% of respondents would refer to endocrinology to supervise weaning, whilst 12.5% would confirm with a random or early morning cortisol. 14.6% of respondents would arrange an SST. Amongst the respondents, 71.7% reported relapse of the underlying condition, 8.7% reported symptoms of GC-AI and 8.7% reported symptoms of GC withdrawal.

Discussion: The guidelines correctly suggest that Endocrinologists should not be involved in therapeutic GC tapering. As reported here, relapse of the underlying condition is common, and endocrinology input may not be appropriate when this occurs. However, there is huge variation in the rate of GC weaning and evidence-based research establishing effective GC weaning protocols at physiological doses is indicated.