Glucocorticoids such as cotisone are powerful anti-inflammatory drugs. They work, in part, by blocking eicosanoid production, and in part by blocking other inflammatory pathways.

Glucocorticoids affect eicosanoid synthesis and eicosanoid action:

• Glucocorticoids activate the synthesis of annexin-1 in leukocytes.
• Within the leukocyte, annexin-1 is a potent inhibitor of phoapholipase A2 (cPLA2).
• Decreased cPLA2 activity decreases arachidonic acid production.
• Decreased arachidonic acid decreases both prastanoid and leukotriene production.

• Annexin-1 is also released from leukocytes.
• The annexin-1 that is released activates the lipoxin ALXR receptor.
• Activation of ALXR promotes the resolution of the inflammatory response.

• Glucocorticoids also decrease the amount of COX-2 that is synthesized, further lowering prostanoid synthesis.

Glucocorticoids also block other inflammatory pathways.