The concept of «administration» of glucocorticoid therapy: is there a safe zone for low-dose methylprednisolone?
Zviahina O.V.1, Afanasieva I.O.2
Summary. The article is devoted to the current problem of modern rheumatology— the evolution of views on the long-term safety of low and ultra-low doses of glucocorticoids (GC) within the concept of «administration». Based on the analysis of the latest scientific discussion published in the pages of the journal The Lancet Rheumatology (2026), the limits of safety of long-term administration of hormones are considered. The material is fully adapted to the realities of domestic clinical practice by translating European recommendations into methylprednisolone equivalent. The work substantiates the pharmacological advantages of methylprednisolone (low mineralocorticoid activity) in comorbid patients and describes in detail a step-by-step algorithm for guided patient management — from primary screening to concomitant prevention of osteoporosis and metabolic disorders. Special emphasis is placed on the practical aspects of titration of ultra-low doses (2 mg and 1 mg): the rules for precise crushing of the 4 mg Metipred tablet using pharmacy pill splitters are given, and the use of an intermittent (alternative) dosing regimen (4 mg every other day in the morning) is justified as a rational method of reducing risks in patients with low compliance.
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