New Recommendations on Glucocorticoid Treatment for People with Neuromuscular Disorders

A multidisciplinary expert panel has released new consensus-based recommendations on glucocorticoid use for people with neuromuscular disorders, aiming to streamline clinical decisions amid a lack of specific, formal guidelines. Published in Muscle and Nerve, the guidance aims to support safer, more consistent care for patients treated with corticosteroids across a range of neuromuscular conditions.

Despite their widespread use, glucocorticoids carry significant risks, and clinicians have had limited structured guidance on mitigating those harms. The new guidelines synthesize expert opinion and a multidisciplinary literature review to address gaps in evidence regarding management of potential complications associated with glucocorticoid treatment. Recommendations cover bone health, infection risk, vaccine administration, ophthalmologic screening, and steroid tapering protocols.

Key recommendations from the article include:

• The initiation of osteoporosis prevention for patients on any dose of glucocorticoids for >3 months, consisting of a recommended dose of 600 to 800 IU/day vitamin D and calcium supplementation
• The use of pneumocystis jirovecii pneumonia (PJP) prophylaxis only when the estimated annual infection risk exceeds 3.5%, with consideration for comorbid risk factors such as use of multiple immunosuppressive agents or underlying lung disease
• Limiting use of proton pump inhibitors to patients with peptic ulcer risk factors (eg, nonsteroidal anti-inflammatory drug [NSAID] use) while avoiding routine initiation
• The strong recommendation of zoster, pneumococcal, and influenza vaccines before steroid initiation
• The inclusion of hepatitis B and tuberculosis screening and referral to ophthalmology if steroids are used >6 months

“Up until this point there really hasn't been specific guidance,” said Charles Kassardjian, MD, MSc, Lead Author and Assistant Professor of medicine at the University of Toronto. “Having one place where you can summarize everything, I think, is very valuable.”

The full article containing international consensus guidance is available through the Wiley Online Library: https://onlinelibrary.wiley.com/doi/full/10.1002/mus.28328