Neurológia pre prax 6/2011

Basic principles of corticosteroid treatment in autoimmune neuromuscular disorders

Corticosteroids are the most widely and frequently used immunomodulatory agents. The immunosuppressive and anti-inflammatory effects of corticosteroids have several components. Corticosteroids induce peripheral blood neutrophilia, whereas T-cells, monocytes, and eosinophils are depleted from blood. Steroids alter functional properties of T-cells and monocytes, act on synthesis and secretion of cytokines and immune mediators, and have effect on microvascular permeability. For autoimmune neuromuscular diseases treatment with corticosteroids can be extended over many years (e.g., myasthenia gravis, polymyositis, dermatomyositis, CIDP, etc), for other diseases corticosteroid treatment is limited to a short period time (e.g., multiple sclerosis). An aggressive approach with high-dose prednisone beginning early in the diseases is recommended. A high dose of at least 1 mg/kg as a single daily morning dose in initial period is prefered. Treatment with corticosteroids can be associated with side reactions. When corticosteroid treatment becomes mandatory, efforts must focus on minimizing corticosteroids side effects while maintaining therapeutic efficacy. The single-dose, alternate-day program minimizes adverse effects while adequately maintaining control of underlying disease.

Keywords: corticosteroids, mechanism of action, treatment, general principles, side effects.