Mechanism of Action of Prednisone and Its Clinical Implications

Molecular Mechanisms and Physiological Effects

• The American College of Rheumatology notes that prednisone directly affects T-cell function, promoting HBV DNA replication through interaction with the HBV glucocorticoid responsive element in patients with hepatitis B 1
• The European Association for the Study of the Liver reports that prednisone increases insulin resistance at the liver, promotes a liver lipogenic program, has catabolic actions on bone and muscle, mobilizing amino acids for gluconeogenesis, and suppresses the reproductive axis, resulting in sex steroid deficiency 2

Clinical Implications and Pharmacological Considerations

• The American Thoracic Society indicates that the anti-inflammatory effects of prednisone are dose-dependent, with higher doses (>10 mg daily) having more pronounced effects but also more side effects 3
• The National Institute of Neurological Disorders and Stroke states that prednisone is a prodrug that must be converted to prednisolone in the liver to become active, and prednisone and prednisolone are often used interchangeably in clinical practice with similar efficacy 4