corticosteroïdesparende

Corticosteroïde-sparing, or corticosteroid-sparing, refers to medical strategies that aim to reduce or avoid the use of systemic corticosteroids (glucocorticoids) while preserving disease control. The approach relies on substituting corticosteroids with alternative therapies or using them at the lowest effective dose. The term corticosteroïdesparende is used in some languages to describe this concept.

Rationale and scope: Prolonged systemic corticosteroid therapy is associated with adverse effects such as osteoporosis, hyperglycemia, hypertension, weight gain, infections, cataracts, mood changes, and suppression of the hypothalamic-pituitary-adrenal axis. Reducing steroid exposure can improve safety and quality of life, particularly in chronic inflammatory and autoimmune diseases.

Strategies and agents: steroid-sparing regimens combine non-steroidal therapies that control inflammation, including immunosuppressants (methotrexate, azathioprine, mycophenolate mofetil, leflunomide), calcineurin inhibitors, and biologics (TNF inhibitors, IL-6 inhibitors, rituximab), or targeted therapies (JAK inhibitors). In dermatology, topical steroids and calcineurin inhibitors are used with tapering to minimize systemic exposure.

Evidence and considerations: Efficacy varies by disease; tapering plans are individualized and commonly involve gradual reduction with close monitoring for relapse. Safety concerns include infections, cytopenias, liver or kidney toxicity, and drug interactions. Patient factors such as age, pregnancy, and comorbidities influence choices and dosing.

See also: corticosteroids; steroid-sparing strategies in specific diseases; long-term management of inflammatory diseases.