Twice daily fractionated dose administration of prednisolone compared to standard once daily administration to patients with glomerulonephritis or with kidney transplants.
BACKGROUND
Pharmacokinetic half-life of prednisolone is 2-3 h, indicating short pharmacodynamic effect duration. Therefore, the fractionated twice daily administration of prednisolone might be favorable.


METHODS
A 6-month observational study was conducted in a total of 51 patients, 35 with glomerulonephritis and 16 with kidney transplants. Low-dose and long-term prednisolone was given twice daily to 37 patients and once daily to 14 patients.


RESULTS
The median dose (first-third quartile) for fractionated prednisolone was 2 x 1.25 mg/day (2.5-2.6) and significantly lower (p = 0.008) than the once daily standard dose of 1 x 4.0 mg/day (2.5-5.0). The number of comedications was also significantly lower in the fractionated dose group: 1.0 co-immunosuppressant (0.0-1.0) compared to 1.5 drugs (0.25-2.0) such as cyclosporine and/or mycophenolate (p = 0.017), and 0.0 antidiabetics (0.0-0.0) versus 0.0 drugs (0.0-0.75) such as gliquidone (p = 0.032). The fall in proteinuria was significant in the fractionated dose group with -0.12 g/l (-0.4-0.0) versus +0.08 g/l (-0.04-+0.24) in controls (p = 0.008).


CONCLUSIONS
Twice daily fractionated administration of prednisolone allows a lower daily dose (total 2.5 mg/day), and appears to be as efficient but less diabetogenic compared to the standard once daily dosing (4.0 mg/day).
Decker
Sebastian Oliver
SO
Nephrology, Ulm University, Ulm, Germany.
Keller
Frieder
F
Mayer
Jens
J
Stracke
Sylvia
S
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008134:Long-Term Care; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D011239:Prednisolone; D002118:Calcium