CD4+ and CD8+ lymphocyte and cortisol response patterns in elderly and young males after methylprednisolone exposure

The elderly have impaired cellular immunity and are more predisposed to opportunistic infections after long term glucocorticoid treatment. No data, examining the response of lymphocyte subsets (CD4+, CD8+) under baseline conditions and after exposure to methylprednisolone in young and elderly males, are available. This crossover study examined lymphocyte subsets and cortisol response patterns in seven elderly males (66-82 years) and five young males (24 are examined, a dose-response relationship may be evident among young healthy volunteers who received different doses of methylprednisolone and exhibited different lymphocyte response ratios (Dunn, Ludwig et al, 1991; Fisher, Ludwig et al., 1992). In summary, reduced methylprednisolone clearance is present in the elderly accompanied by enhanced cortisol suppression, but there is no increase in lymphopenia. This preliminary study has found that elderly subjects have a lower baseline CD4+ count and experience a considerable time during which the CD4+ count may be < 200 cells/mm³ following a single dose of methylprednisolone. Therefore, lymphocyte subset patterns may be a reasonable monitoring parameter for patients who require long-term methylprednisolone treatment. Other investigators have described a reduced function for lymphocytes among elderly patients (Cueppens and Goodwin, 1982; Delafuente, 1985; Hallgren, Jackola et al., 1983; Rosenkoetter, Antel et al., 1983; Song, Kim et al., 1993). Therefore, future studies will need to consider not only the number of circulating lymphocytes, but also their ability to respond to an antigenic stimulus in patients who require long-term immunosuppression with methylprednisolone. The fact that the pharmacologic response to methylprednisolone that we studied (i.e., lymphocyte patterns), was not altered does not necessarily indicate that other responses will not be influenced by prolonged drug clearance. For example, biochemical, cardiovascular, bone changes, etc., may be influenced to varying degrees by altered methylprednisolone pharmacokinetics in the elderly and these issues are currently under investigation.