Corticosteroids (Prednisone)
Broad immunosuppression via NF-kB inhibition and anti-inflammatory gene transcription
- Response rate
- ~60%
- Onset
- Days
- Route
- Oral 0.5-1 mg/kg/day; IV pulse for severe flares
- Line
- 1st
- IgM effect
- Rapid ferritin reduction
Evidence summary
Mainstay of initial treatment, controlling about 60% of patients. High-dose regimens (1 mg/kg/day prednisone) are more effective than low-dose as first-line and may promote a monocyclic disease course. However, approximately 45% of patients develop steroid dependency, necessitating steroid-sparing agents. IV methylprednisolone pulses used for severe systemic disease and MAS.