Twice Daily Fractionated Dose Administration of Prednisolone Compared to Standard Once Daily Administration to Patients with Glomerulonephritis or with Kidney Transplants

Pharmacokinetic half-life of prednisolone is 2-3 h, indicating short pharmacodynamic effect duration. Therefore, the fractionated twice daily administration of prednisolone might be favorable. A 6-month observational study was conducted in a total of 51 patients, 35 with glomerulonephritis and 16 with kidney transplants. Low-dose and long-term prednisolone was given twice daily to 37 patients and once daily to 14 patients. The median dose (first - third quartile) for fractionated prednisolone was 2 x 1.25 mg/day (2.5 - 2.6) and significantly lower (p = 0.008) than the once daily standard dose of 1 x 4.0 mg/day (2.5 - 5.0). The number of comedications was also significantly lower in the fractionated dose group: 1.0 co-immunosuppressant (0.0 - 1.0) compared to 1.5 drugs (0.25 - 2.0) such as cyclosporine and/or mycophenolate (p = 0.017), and 0.0 antidiabetics (0.0 - 0.0) versus 0.0 drugs (0.0 - 0.75) such as gliquidone (p = 0.032). The fall in proteinuria was significant in the fractionated dose group with -0.12 g/l (-0.4 - 0.0) versus +0.08 g/l (-0.04 - +0.24) in controls (p = 0.008). Twice daily fractionated administration of prednisolone allows a lower daily dose (total 2.5 mg/day), and appears to be as efficient but less diabetogenic compared to the standard once daily dosing (4.0 mg/day).