Delayed-release prednisone - a new approach to an old therapy.

INTRODUCTION: 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. AREAS COVERED: 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. EXPERT OPINION: Delayed-release prednisone offers an effective way to improve the benefit:risk ratio of GC treatment for inflammatory conditions with circadian features.