Patients requiring oral corticosteroids should be weaned slowly from systemic corticosteroid use after transferring to Advair Diskus. Prednisone reduction can be accomplished by reducing the daily prednisone dose by mg on a weekly basis during therapy with Advair Diskus. Lung function (mean forced expiratory volume in 1 second [FEV 1 ] or morning peak expiratory flow [AM PEF]), beta-agonist use, and asthma symptoms should be carefully monitored during withdrawal of oral corticosteroids. In addition, patients should be observed for signs and symptoms of adrenal insufficiency, such as fatigue, lassitude, weakness, nausea and vomiting, and hypotension.
The most common immunosuppression regimen used in patients after liver transplant is the combination of calcineurin inhibitor, usually tacrolimus, with prednisone. Recurrence of AIH in the transplanted liver can occur in 25% to 30% of the cases and seems to be more common when prednisone is discontinued. 41,42 Thus prednisone is usually continued at low doses after transplant. Autoimmune hepatitis recurrence in the liver transplant can often be successfully treated by reintroducing prednisone and optimizing calcineurin inhibitors. A combination of prednisone and azathioprine has also been used to treat recurrent AIH. These patients have a similar prognosis as transplanted patients who do not have recurrent AIH. 41