Steroid-Induced Immunomodulation in Clinical Practice: Navigating the Fine Line between Therapeutic Benefits and Immunosuppression Risks

Steroids, particularly glucocorticoids, are integral in managing a broad spectrum of clinical conditions due to their potent anti-inflammatory and immunosuppressive properties. This review explores the mechanisms through which steroids modulate immune function, offering therapeutic benefits in autoimmune diseases, respiratory disorders, organ transplantation, and cancer therapy. However, the immunosuppressive effects of steroids pose risks such as increased susceptibility to infections, reactivation of latent infections, osteoporosis, and metabolic disturbances. Balancing therapeutic efficacy and immunosuppressive risks is a major clinical challenge. Strategies such as tailored dosing regimens, steroid-sparing agents, prophylactic measures, and the development of selective glucocorticoid receptor modulators (SEGRMs) are discussed as potential solutions for optimizing patient outcomes while minimizing adverse effects. This review highlights the need for ongoing research to refine steroid therapy, ensuring a careful balance between therapeutic benefits and immunosuppression risks in clinical practice. Keywords: Steroid-induced immunomodulation, glucocorticoids, autoimmune diseases, immunosuppression, infections.