Will we ever have better glucocorticoids?

Glucocorticoids are cost-effective drugs with potent anti-inflammatory and immunosuppressive effects. They are used successfully to treat many disorders, including rheumatoid arthritis, polymyalgia rheumatic and other rheumatic diseases. However, these drugs also have the potential to cause adverse effects, particularly if high doses are used for prolonged periods. Therefore, continuous efforts are being made to implement recommendations for optimal dosing of glucocorticoids, monitoring for potential adverse events, adverse event prevention and management. Apart from this, novel and interesting work is underway to develop innovative glucocorticoids or glucocorticoid receptor ligands in order to improve the therapeutic balance. This article briefly mentions a recent publication discussing the question under which conditions long-term treatment with glucocorticoids has an acceptably low level of harm, and focuses then on two current approaches to minimize glucocorticoid adverse effects while keeping or even enhancing their anti-inflammatory efficacy, liposomal glucocorticoids and dissociated agonists of the glucocorticoid receptor.