Regarding the use of prednisolone and other immunosuppresive drugs in ME/CFS
These results from two very small uncontrolled trials here in the UK were never properly reported in the literature and date back 30 years:
Prednisolone at 10 to 60 mg/day produced no overall benefit and anecodotal reports from several patients who have been prescribed higher doses of steroids also indicates that while a few have reported some improvement this has not been so for most cases and some people have felt worse, or much worse
A two month course of prednisolone at 30mg per day, with or without azathioprine (another immunosuppresive) at 150 mg/day, was also tried in 10 cases but no change was reported. In fact, this group were more symptomatic at the end of the course
The sooner we get to grips with the fact that there various clinical phenotypes and disease pathways under the ME/CFS umbrella the better
It's rather like placing anyone with any type of joint disease - mechanical, infective, inflammatory - under a chronic joint pain syndrome and saying that they all have the same underlying pathology and will therefore respond to the same approach to treatment
@charles shepherd and
@DanME
From time to time on this forum there are threads where those who have benefited from hydrocortisone/cortisol, or not, have been discussed. My understanding is that if the adrenal gland were completely non-functional, a full replacement dose would be between 30-40 mg hydrocortisone or cortisol. Prednisone, however, is 4X stronger, so that would mean a maximum of 10 mg prednisone would be a full replacement dose.
A number of people with ME seem to have a lack of cortisol either through a lack of timely response to need by the HPA or perhaps through some form of resistance to it--I don't know. However, these people can benefit from low-dose cortisol supplementation.
I am one of them, having been using 5 mg twice a day for many years. It has helped my condition a great deal, without any adverse side efffects. It also improves my immunity. The sore throat and flu symptoms I used to get with any over exertion (meaning approximating a normal day) were banished. Some others on this forum have had the same benefit.
This kind of supplementation of cortisol may not be what this thread is driving at--the question of whether or not very high doses well beyond a physiological replacement dose could be of benefit. Instead it is along the lines of taking additional thyroid medicine for a low-performing thyroid gland. Except that in the case of this group of MEs, the health of the adrenal gland is not the problem but rather the lack of adequate signalling from the HPA, most likely.
My impression is that this low-dose supplementation has not been adequately tested in proper studies. Either excessive doses were tried, or the patient group may have been poorly chosen via the conflation of ME/CFS with Depression--and it has been found that those with Depression have excess cortisol rather than a lack of it--so I don't think this avenue for treatment, not cure, for at least some MEs has been adequately looked into yet.
Safe Uses of Cortisol by Dr. William Mackenzie Jefferies, M.D., 1996, is a resource of information for the history of the use of cortisol and its value in low doses for a number of conditions, including ours.