What is the recommended approach to tapering prednisone after a response?

• A. Immediately discontinue prednisone after a response.
• B. Gradually reduce the dose over several weeks to months while monitoring for relapse.
• C. Increase the dose to maintain remission.
• D. Switch to an alternative immunosuppressant without tapering.

Answer: (B)

After a positive response to prednisone, the goal is to keep the patient in remission while minimizing steroid exposure, which is best achieved by tapering gradually over several weeks to months with close monitoring for relapse. This slow reduction lets the body's own cortisol axis recover and reduces long-term side effects, while also giving you a window to catch and respond to any return of symptoms early. If relapse occurs, you can adjust the taper pace rather than stopping abruptly or indefinitely increasing the dose. Stopping suddenly risks relapse and withdrawal effects; increasing the dose to maintain remission just prolongs exposure; and switching to another immunosuppressant without tapering misses the opportunity to safely step down the steroid while preserving control.