{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:47:39Z","timestamp":1767797259091,"version":"3.49.0"},"reference-count":18,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000268","name":"Biotechnology and Biological Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000268","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","award":["23\/0006515"],"award-info":[{"award-number":["23\/0006515"]}],"id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,18]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Study objective<\/jats:title>\n                    <jats:p>Prolonged glucocorticoid (GC) use is associated with significant morbidity and mortality, including the development of GC induced adrenal insufficiency. Recent guidance from the European Society of Endocrinology and Endocrine Society provides a framework for tapering GCs. However, there is limited understanding of current practice across endocrine and other medical specialties, including barriers and challenges to GC weaning. This study aimed to establish how GCs are weaned in patients across endocrine and non-endocrine specialists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Anonymous online surveys were disseminated to all members of the Society for Endocrinology and all members of the Association of Southeast Asian Nations Federation of Endocrine Societies and the Endocrine and Metabolic Society of Singapore. Non-endocrine specialists were surveyed in the UK and in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 306 (258 endocrine specialists and 48 non-endocrine specialists) responded to the survey. Approaches to discontinuing prednisolone were heterogeneous. Among endocrine respondents, only 78% would fully wean the prednisolone, with 50.4% switching to hydrocortisone to wean and 12.6% favouring long-term GC replacement without further investigations. Among the non-endocrine respondents, 16.7% would stop prednisolone abruptly and 10.4% would refer to endocrinology to supervise weaning. The most common barrier to weaning GCs reported by both endocrine and non-endocrine specialists was relapse of the underlying condition (55.9% and 70.8%,\u2009respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Relapse of the underlying condition is common, and endocrinology input may not be appropriate when this occurs. There remains a need to develop an evidence-based approach for safe and effective GC weaning and hypothalamic\u2013pituitary\u2013adrenal axis assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107269","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:10:19Z","timestamp":1767111019000},"page":"e107269","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Weaning patients off long-term prednisolone: a survey of physicians\u2019 practice in the UK and Southeast Asia"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0758-7839","authenticated-orcid":false,"given":"Katharine","family":"Lazarus","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4172-1344","authenticated-orcid":false,"given":"Pei Chia","family":"Eng","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"},{"name":"Department of Endocrinology, National University Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7453-9039","authenticated-orcid":false,"given":"Kavita","family":"Narula","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2429-005X","authenticated-orcid":false,"given":"Sirazum","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7557-7803","authenticated-orcid":false,"given":"Deborah","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-2762","authenticated-orcid":false,"given":"Niamh M","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Wernig","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5873-3432","authenticated-orcid":false,"given":"Tricia","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7112-2756","authenticated-orcid":false,"given":"Karim","family":"Meeran","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Department of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026010703532881000_15.12.e107269.1","first-page":"833","article-title":"Dose-Response Relationship Between Long-Term Systemic Corticosteroid Use and Related Complications in Patients with Severe Asthma","volume":"22","author":"Dalal","year":"2016","journal-title":"J Manag Care Spec Pharm"},{"key":"2026010703532881000_15.12.e107269.2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-119-10-199311150-00001"},{"key":"2026010703532881000_15.12.e107269.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003432","article-title":"Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: A population-based cohort study","volume":"17","author":"Pujades-Rodriguez","year":"2020","journal-title":"PLoS Med"},{"key":"2026010703532881000_15.12.e107269.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-017-0614-x","article-title":"The cost of systemic corticosteroid-induced morbidity in severe asthma: a health economic analysis","volume":"18","author":"Barry","year":"2017","journal-title":"Respir Res"},{"key":"2026010703532881000_15.12.e107269.5","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1164\/rccm.202010-4001ED","article-title":"Oral Corticosteroids Tapering in Severe Asthma","volume":"203","author":"Boulet","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"2026010703532881000_15.12.e107269.6","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/joim.13273","article-title":"Long-term corticosteroid use, adrenal insufficiency and the need for steroid-sparing treatment in adult severe asthma","volume":"290","author":"Gurnell","year":"2021","journal-title":"J Intern Med"},{"key":"2026010703532881000_15.12.e107269.7","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1210\/clinem\/dgae250","article-title":"European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency","volume":"109","author":"Beuschlein","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"2026010703532881000_15.12.e107269.8","unstructured":"Adrenal insufficiency: identification and management nice guideline. NICE guideline [NG243]; 2024."},{"key":"2026010703532881000_15.12.e107269.9","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06737-1"},{"key":"2026010703532881000_15.12.e107269.10","doi-asserted-by":"crossref","first-page":"e2031","DOI":"10.1210\/clinem\/dgae059","article-title":"A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic-Pituitary-Adrenal Axis","volume":"109","author":"Arshad","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"2026010703532881000_15.12.e107269.11","doi-asserted-by":"crossref","DOI":"10.1530\/EC-23-0097","article-title":"Optimising prednisolone or prednisone replacement in adrenal insufficiency","volume":"12","author":"Sharma","year":"2023","journal-title":"Endocr Connect"},{"key":"2026010703532881000_15.12.e107269.12","doi-asserted-by":"crossref","first-page":"A98","DOI":"10.1210\/jendso\/bvab048.197","article-title":"The Majority of Inpatient Short Synacthen Tests Are Performed Incorrectly, Due to Imprecise Timing, Incorrect Sampling and Failure to Interrupt Steroid Administration","volume":"5","author":"McCarthy","year":"2021","journal-title":"J Endocr Soc"},{"key":"2026010703532881000_15.12.e107269.13","doi-asserted-by":"publisher","DOI":"10.1258\/acb.2009.009209"},{"key":"2026010703532881000_15.12.e107269.14","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/cen.14934","article-title":"\u201cA morning cortisol is the most effective clinical predictor of short synacthen test outcome\u201d: A tertiary care centre experience","volume":"99","author":"Mathara Diddhenipothage","year":"2023","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2026010703532881000_15.12.e107269.15","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/cen.15077","article-title":"Diagnostic accuracy of morning serum cortisol concentration in confirming recovery of the hypothalamic-pituitary-adrenal axis in patients on chronic glucocorticoid therapy","volume":"101","author":"Sharma","year":"2024","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2026010703532881000_15.12.e107269.16","doi-asserted-by":"crossref","unstructured":"Baker EH . Is there a safe and effective way to wean patients off long-term glucocorticoids? Br J Clin Pharmacol 2020. doi:10.1111\/bcp.14679","DOI":"10.22541\/au.159493291.16885702"},{"key":"2026010703532881000_15.12.e107269.17","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad073"},{"key":"2026010703532881000_15.12.e107269.18","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/MED.0000000000000804","article-title":"Glucocorticoid withdrawal syndrome: what to expect and how to manage","volume":"30","author":"Theiler-Schwetz","year":"2023","journal-title":"Curr Opin Endocrinol Diabetes Obes"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107269","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:54:48Z","timestamp":1767786888000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,30]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-107269"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107269","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}