Treatment: long-term corticosteroids

Internal medicine and immunology · Treatment monitoring · updated 2026-10-30

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: About 0.7% of French adults (2014) have at least six reimbursed oral corticosteroid dispensings a year, reflecting long-term corticosteroid treatment; 17% had at least one in the year ^[1].

Treatment: long-term corticosteroids

Fasting sample.

Fasting laboratory tests

FBC
Serum electrolytes
Serum creatinine with eGFR
AST
ALT
GGT
Alkaline phosphatase
Fasting plasma glucose
Lipid profile
25-hydroxyvitamin D
HbA1c (person at risk of diabetes)if neededThe PNDS for giant cell arteritis (HAS 2024) suggests, if possible before corticosteroid therapy, a fasting venous plasma glucose and an HbA1c in people at risk, that is, in case of overweight, personal or family history of diabetes or gestational diabetes ^[3].
HIV serology (if risk factor)if neededThe PNDS lists HIV serology “if risk factors” (history of severe infection, risk of exposure) before systemic corticosteroid therapy ^[4].
Hepatitis B serology (HBsAg, anti-HBs, anti-HBc)if neededThe PNDS limits it to patients with risk factors ^[4]; the APASL recommends doing it in every patient about to receive an immunosuppressive treatment, prednisone ≥ 10 mg/day for ≥ 4 weeks being among the situations at risk of reactivation ^[5].
Hepatitis C serology (if risk factor)if neededThe PNDS lists hepatitis C serology “if risk factors are present” before systemic corticosteroid therapy ^[4].
IGRA (if corticosteroids at more than 15 mg/day prednisone equivalent for more than 4 weeks, or risk factor for tuberculosis)if needednon-French guidelineEULAR (2022) suggests considering screening for latent tuberculosis before corticosteroid therapy, especially beyond 15 mg/day of prednisolone for more than 4 weeks or in the presence of a risk factor (tuberculosis contact, living in an endemic country, etc.), by chest X-ray and an IGRA test, preferred to the tuberculin skin test ^[6]. NICE counts prolonged corticosteroid therapy among the causes of immunosuppression: it assesses the risk (degree and duration of immunosuppression, country of birth, contact), then considers an IGRA ^[7]. In France, the PNDS for giant cell arteritis asks to discuss antituberculosis prophylaxis in case of recent contact, old untreated tuberculosis or a positive tuberculin test, without requesting routine testing ^[3]; IGRA is not reimbursed in France for this indication ^[8].
Strongyloides serology (if stay in a strongyloidiasis-endemic area)if neededThe PNDS suggests it as “±” in case of a history of stay in an endemic area ^[4]; the SmPC of prednisone asks for stool parasitological examination and routine eradication treatment before corticosteroid therapy in anyone coming from an endemic area ^[9]. The ivermectin course should not wait for the result ^[4].
Stool parasitology (person from a strongyloidiasis-endemic area)if neededRequested by the SmPC of prednisone before corticosteroid therapy in everyone coming from an endemic area (tropical and subtropical regions, southern Europe), with routine eradication treatment ^[9].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Do not order

Bone turnover markers (CTX, P1NP, etc.): no evidence of value in corticosteroid-induced osteoporosis, use not recommended to predict fracture risk (grade A) ^[10].
Routine calcium drug supplementation: not recommended (grade A); aim for dietary intakes of 800 to 1 200 mg/day ^[10].

During treatment

Fasting sample.

Fasting laboratory tests

Fasting plasma glucose
Serum electrolytes
Lipid profile
HbA1c (diabetic patient)if neededThe PNDS cites glycated haemoglobin in addition to fasting plasma glucose; the efficacy of insulin, metformin and sulfonylureas is reduced by prednisone, the antidiabetic possibly needing adjustment during treatment and after its discontinuation ^[4,9]. Test reimbursed in France “only for monitoring glycaemic control” (code 1577) ^[2]. The PNDS for giant cell arteritis suggests an HbA1c and a fasting lipid profile every 3 months on corticosteroid therapy ^[3]; outside monitoring of glycaemic control, code 1577 is not reimbursed ^[2].
Serum creatinine with eGFR (systemic sclerosis, prednisolone dose ≥ 15 mg/day)if neededThe SmPC reports an increased incidence of scleroderma renal crisis from 15 mg/day of prednisolone: blood pressure and serum creatinine to be checked regularly ^[9].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Also consider

Stopping corticosteroids? Stopping is always gradual after prolonged treatment: see the page "Insuffisance surrénalienne lente".

Sources (16)