A different look at pulsed glucocorticoid protocols; Is high dose oral prednisolone really necessary just after initiation of pulse therapy?

Pulse glucocorticoid therapy is pivotal in severe and life threatening forms of rheumatic and immune-mediated conditions. High dose oral prednisolone has numerous adverse effects and should be balanced with the advantages. Minimal effective dose of most drugs warrants minimal systemic and local side effects. There are limited controlled trials to validate optimal or minimal effective dose, duration and interval of pulse therapies. Considering the relative high biologic half-life of pulsed methylprednisolone, we hypothesize that oral high dose prednisolone could be changed to rather low oral dose during monthly pulse intravenous methylprednisolone.