title: Delayed-release prednisone - a new approach to an old therapy.
abstract: BACKGROUND
  Despite the widespread use of glucocorticoid (GC) treatment for inflammatory conditions, there remains a need to optimize use by improving efficacy and/or reducing adverse consequences. The most advanced approach, already licensed for clinical use, is delayed-release prednisone.
  
  
  METHODS
  Delayed-release prednisone consists of an inert outer coat containing an inner core of active drug (1, 2, or 5 mg) taken at bedtime (approximately 22:00 h). After a lag time of 4 - 6 h, the coat opens to release prednisone, at the appropriate time to counteract elevated nocturnal levels of pro-inflammatory cytokines associated with the circadian pattern of symptoms seen in rheumatoid arthritis (RA) and other inflammatory conditions. Clinical trials in RA have demonstrated the improved efficacy of delayed-release prednisone with respect to morning stiffness compared with conventional immediate-release prednisone tablets taken in the morning and compared with placebo in patients on disease-modifying antirheumatic treatment; the incidence of adverse events was similar to the comparator. Preliminary studies in polymyalgia rheumatica and asthma suggest that delayed-release prednisone may also have benefits in these conditions.
  
  
  CONCLUSIONS
  Delayed-release prednisone offers an effective way to improve the benefit:risk ratio of GC treatment for inflammatory conditions with circadian features.
authors.affiliation: Charité University Medicine, Department of Rheumatology and Clinical Immunology, Charitéplatz 1, 10117 Berlin, Germany. frank.buttgereit@charite.de
authors.forename: Frank
authors.initials: F
authors.lastname: Buttgereit
authors.forename: Allan
authors.initials: A
authors.lastname: Gibofsky
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000378:metabolism; D003692:Delayed-Action Preparations / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D011241:Prednisone