Key Finding: Safe Weaning of Glucocorticoids in Children
In a retrospective study from a tertiary pediatric hospital, researchers followed children aged one month to under 16 who received supraphysiological glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis (JIA). Across 2,363 patient months of treatment and follow-up, the incidence of adrenal crisis during tapering was remarkably low, suggesting that careful taper protocols can reduce clinically significant adrenal suppression.
Study Overview: Design and Cohort
The investigators conducted a single-center, retrospective observational analysis. Monthly data captured treatment regimens and monitored for indicators of adrenal crisis, including emergency department visits, electrolyte disturbances, coding entries, and clinical team reports. The cohort included children treated for nephrotic syndrome or JIA with glucocorticoids given at supraphysiological doses for several weeks, followed by a structured taper.
The Weaning Process: From Daily to Alternate-Day Dosing
As glucocorticoids were tapered, all children with nephrotic syndrome and a subset of those with JIA transitioned to alternate-day dosing after a period of daily supraphysiological therapy. Importantly, there were no adrenal crisis events identified in the 974 patient months that occurred after glucocorticoids were discontinued. The findings held when compared with other published cohorts, suggesting that the observed low crisis rate is not merely a result of sample size.
Clinical Implications: How to Safely Taper
The study supports the use of structured taper protocols managed by specialists, with rapid access to medical advice for families. Key takeaways for practice include:
- Consider alternate-day regimens after an initial period of daily high-dose therapy to mitigate adrenal suppression while maintaining disease control.
- Discharge instructions should clearly outline signs of adrenal insufficiency and when to seek urgent care, with standardized language to aid families.
- Routine biochemical testing during tapering may be reserved for complex cases or prolonged high-dose exposure.
During intercurrent illness or stress, families should have expedited access to clinician advice and a plan for stress dosing, ensuring rapid response if adrenal suppression occurs.
Relevance for U.S. Practice
These results advocate for structured taper protocols in pediatrics, emphasizing family education and streamlined clinician support. Hospitals should validate local escalation paths for suspected adrenal crisis and coordinate discharge guidance to minimize ambiguity. While the study is retrospective and single-center, its implications align with broader efforts to balance effective disease control with minimized steroid-related risks.
Takeaway: Safer Weaning Is Possible
For children treated for nephrotic syndrome or JIA with high-dose glucocorticoids for a short course, careful tapering can allow cessation without routine biochemical testing while maintaining safety. Access to a dedicated care team and clear instructions is crucial for successful, crisis-free tapering.
Reference
Finnie J et al. Incidence of adrenal crisis in children and young people receiving high dose glucocorticoids for nephrotic syndrome or juvenile idiopathic arthritis: a retrospective observational study. Arch Dis Child. 2025; doi:10.1136/archdischild-2025-328917.
