50 recurrence risk cidp relapse more common disease course 1 year adults children prednisone daily; by mouth starting dosages adults 50 mg to 100 mg per day children 1 mg kg day single daily dose in the morning maintenance start taper after 3 to 6 months; or when clinical improvement begins taper slowly by 5 mg every 2 to 6 weeks change to intermittent dosing corticosteroids intermittent dosing regimens general principles efficacy similar to more frequent corticosteroid dosing regimens 6,7,8 usual minimum dosing frequency for specific disorders cidp 2 to 6 weeks vasculopathic neuropathies 2 to 6 weeks myasthenia gravis once or twice weekly duchenne muscular dystrophy weekly immune inflammatory myopathies daily to weekly side effects reduced compared to daily dosing corticosteroid regimens may reduce chronic corticosteroid side effects to levels similar to those occurring with ivig may eliminate need for toxic steroid sparing drugs specific side effects likely reduced cushingoid faces growth retardation in children growth of 1 year more than with daily dosing body mass index sleeplessness irritability glucose intolerance cost saving vs chronic ivig treatment 9 25,000 to 100,000 per patient per year 650,000 per quality adjusted life year qaly solumedrol methylprednisolone 8 start 1 gram iv daily for 3 to 5 days maintenance tapering of dose start at 1 gm week iv for 1 month then 1 gm every 2 weeks for 2 months taper further by increased time between doses; reduced total dose change to oral corticosteroid administration dexamethasone, oral for cidp6 total dose 160 mg every 4 weeks dosage schedule 40 mg a day for 4 consecutive days prednisone for duchenne muscular dystrophy7 total weekly dose 5 to 10 mg kg dosage schedule on weekends; half on friday night half on saturday night monitor weight; blood pressure; blood glucose electrolytes; ocular exam advantages of corticosteroid therapy short onset of action 1 to 3 months effective in majority of patients with specific disease indications can be used in pregnancy inexpensive disadvantages of corticosteroid therapy transient initial severe exacerbation, usually after 1 to 3 weeks 2 to 5 side effects many long-term especially with daily, or multiple daily, dosing fewer with intermittent corticosteroid dosage drug combinations corticosteroids azathioprine steroid sparing cyclophosphamide additional efficacy, but high toxicity medications to prevent osteoporosis.
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