Glucocorticoid reduction after starting crinecerfont in adult patients with classic congenital adrenal hyperplasia (CAH): practical perspectives

Individualize glucocorticoid (GC) reduction by patient's therapeutic goals, cortisol needs, lifestyle preferences and clinician's experience, setting targets for clinical parameters, androgens and GC regimen

Reduce GC doses gradually to minimize risk of GC withdrawal symptoms or adrenal insufficiency

Adjust GC to the lowest dose maintaining androgens at goal, not below cortisol replacement needs

Consider switching from longer- to shorter-acting GCs (eg, dexamethasone to hydrocortisone), circadian-mimicking dose distribution, and consolidating or eliminating doses to improve adherence