Cogan's Syndrome Requiring Steroid-Sparing Immunosuppressant Therapy
In Cogan's syndrome, corticosteroids are often needed to control inflammation, but prolonged use at higher maintenance doses is not appropriate long-term. When steroid reduction is clinically indicated — due to steroid dependence, frequent relapse requiring repeated courses, or significant corticosteroid-related adverse effects — a steroid-sparing approach is warranted.
Treatment approach (partial)
The protocol involves the addition of a conventional immunosuppressant as the steroid-sparing agent. Several options within this drug class may be considered depending on the clinical context.
The specific agents, selection criteria, and clinical decision points are detailed in the full structured regimen.
References
- Prolonged steroid therapy should not be prescribed long-term at more than 5 to 7.5 mg/day of prednisone without considering steroid-sparing therapy.
- Maintenance therapy with an immunosuppressant/biologic therapy is justified in case of frequent steroid use, steroid dependence, or significant adverse effects.
- Conventional immunosuppressants (including methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide) and/or targeted therapy (preferably infliximab, especially in case of cochleo-vestibular involvement) may be used.
DOI: 10.1016/j.revmed.2024.09.007
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