La Precisión Glucocorticoidea en la era de la Medicina Personalizada: Una Revisión Sistemática y Consenso Multidisciplinario Sobre Farmacodinamia, Optimización de Dosis y Estrategias de Seguridad (2025)

More than seventy years after their discovery, the administration of systemic glucocorticoids remains one of the most ubiquitous and decisive interventions in both hospital and outpatient medicine. However, their use has historically been governed by empirical paradigms that prioritized absolute immunosuppression over metabolic preservation. In 2025, a doctrinal shift grounded in molecular biology is underway, marked by the recognition of a “genomic efficacy ceiling” and the dissociation between therapeutic and toxic effects. This comprehensive review synthesizes current evidence derived from pivotal trials such as PEXIVAS and from clinical guidelines issued by KDIGO, ACR, and EULAR (2024), in order to propose a new standard of care. The pharmacological futility of massive oral doses due to receptor saturation is discussed, pulse therapy is redefined toward reduced-dose regimens to minimize infectious risk, and precise endocrinological algorithms are established for the management of the hypothalamic–pituitary–adrenal axis during drug withdrawal. Finally, the mandatory implementation of a prophylactic “safety package” is proposed as an unavoidable ethical requirement in contemporary prescribing practice.