Table 1.

Glucocorticoid regimens in selected diseases.

Disease	Induction	Tapering	Maintenance	Relapse
INFLAMMATORY RHEUMATIC DISEASES
Giant cell arteritis	- Immediate treatment with 40–60 mg/day* for induction of remission in active GCA** (33)	- Tapering is recommended when the disease is under control to achieve a target dose of 15–20 mg/day* within 2 to 3 months - After 1 year target dose should be ≤ 5 mg/day* (33)	- If long-term therapy is required a dose of 5 mg/day* or less should be used - GC therapy should ideally be tapered to zero as early as clinically feasibly (18)	- Increase to pre-relapse dose or by up to 5–10 mg/day* - Taper within 4–8 weeks to pre-relapse dose - Repeat induction therapy for ischemic complications (34)
Rheumatoid arthritis	- When initiating/changing csDMARDs short-term GC therapy should be considered (35)	- GC tapering should start as soon as clinically feasible (35)	- If long-term therapy is required a dose of 5 mg/day* or less should be used - GC therapy should ideally be tapered to zero as early as clinically feasibly (18)	- Usually doses between 10 and 20 mg/day* are sufficient to treat flares in this disease
Systemic lupus erythematosus	- Therapy depends on disease manifestations and severity (36) - In acute, organ-threatening disease high-dose intravenous pulse therapy (usually 250–1,000 mg/day* for 3 days) is often used (36)	- GC should be tapered or at least minimized as rapidly as clinically feasible	- Long-term aim is to minimize daily dose to ≤ 7.5 mg/day* or to discontinue GC therapy (36)	- The characteristic of flare therapy depends on disease, as has been similarly stated for the induction therapy
ATOPY
Atopic dermatitis	- Stepwise approach: adjust treatment based on disease severity assessed by SCORAD (37)
	→ Mild disease: class II topical glucocorticoids (e.g., flumethasone 0.02%) (38)
	→ Moderate disease: class II/III topical glucocorticoids (e.g., mometasone 0.1%) (39)
	→ Severe disease: short-term oral glucocorticoids may be considered in adults (38)
Allergic rhinitis	- Moderate to severe rhinitis: nasal glucocorticoids, e.g., fluticasone, mometasone, beclametasone (40, 41)
	- Oral glucocorticoids should only be used in severe persisting disease (40, 41)
	- stepped-care approach according to disease severity (42)
Asthma	- Most patients initially receive low dose ICS (e.g., 200–400 μg/d budesonide) (43) - Frequent troublesome symptoms justify medium (400–800 μg/d) to high dose ICS (>800 μg/d) (44) - Low dose oral corticosteroids ( ≤ 7.5 mg/day *) should only be considered in adults with severe asthma or poor symptom control (45)	- ICS should not be stopped completely, cessation is associated with a higher risk of exacerbations (46) - In stable disease ICS doses can be reduced by 25–50% every 3 months (47)	- ICS are recommended as controller treatment in all asthma patients either as-needed or daily depending on disease severity (43) - Dose adjustment according to a stepwise approach*** ranging from 200–400 to >800 μg/d budesonide or comparable doses of other formulations in adults, reduced doses are used in the treatment of children <12 years (48)	- Worsening symptoms: adjustment of the treatment (increase reliever/controller use, step up to higher dose) according to a written asthma action plan*** - Severe exacerbation: → adults: 40–50 mg/d prednisolone → Children: 1–2 mg/kg/d, max. 40 mg/d prednisolone to be continued for 5–7 days (49, 50)
Anaphylactic shock	- Glucocorticoids are used to prevent protracted anaphylactic symptoms, while their efficacy in the acute phase is limited due to slow onset of action (51, 52)
	−250–1,000 mg i.v. prednisolone (weight-adjusted dosing in children) (53)
LEUKEMIA
Chronic lymphoblastic leukemia****	- Patients with diagnosed limited-stage Hodgkin's lymphoma (HL) and a positive interim positron-emission tomography after two cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) should be treated with two cycles of bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone in escalated dose before ISRT
	- Patients with refractory or relapsed HL dexamethasone can be given in combination with high-dose cytarabine/cisplatin (DHAP) before high-dose chemotherapy followed by autologous stem cell therapy
	- Patients diagnosed for nodular lymphocyte predominant Hodgkin lymphoma benefit from the combination of rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone (R-CHOP)
	- CLL patients with transformation into a diffuse large B-cell lymphoma benefit from therapies used in DLBCL such as rituximab plus CHOP (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) (54–56)
Chronic myeloid leukemia	N/A
Acute myeloid leukemia	N/A
Acute lymphoblastic leukemia	- Glucocorticoids are given as a so-called pre-phase therapy (usually prednisone 20–60 mg/day or dexamethasone 6–16 mg/day, both i.v. or p.o.) alone, or in combination with another drug (e.g., vincristine, cyclophosphamide), but often given together with allopurinol and hydration for ~5–7 days. The response to pre-phase therapy defines the chemosensitivity of the disease, and is included in some studies for risk assessment, since good responders to prednisone may have a better outcome.
	- Regimens of induction therapy are centered on vincristine, glucocorticoids, and anthracycline (daunorubicin, doxorubicin, rubidazone, idarubicin), with or without cyclophosphamide or cytarabine. Dexamethasone is often preferred to prednisone, since it penetrates the blood–brain barrier and also acts on resting leukemic blast cells (LBCs).
	- In adult ALL glucocorticoids are often used in the hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) protocol, preferentially used in the United States, but also in other parts of the world
	- Maintenance therapy usually consists of daily 6-mercaptopurine and weekly methotrexate. In some treatment regimens, repeated cycles of vincristine, dexamethasone or other drugs in monthly or longer intervals are given (57)

^*Doses are given as prednisone-equivalent.

^**In patients with GCA suffering from acute visual loss or amaurosis fugax, the use of very high GC dosages, namely 0.25–1 g i.v. methylprednisolone daily for up to 3 days should be considered.

^***Details are provided by the Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2019. Available from: www.ginasthma.org N/A: glucocorticoids are not used as standard therapy in these diseases.

^****The transformation into a diffuse large B-cell lymphoma (DLBCL) or Hodgkin's lymphoma occurs in 2%−15% of CLL patients during the course of their disease.