Intravenous corticosteroids in moderately active ulcerative colitis refractory to oral corticosteroids |
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| Affiliation: | 1. Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Catalonia, Spain;2. Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain;3. Hospital Universitari de Bellvitge, IDIBELL (L''Hospitalet de Llobregat), Catalonia, Spain;1. Department of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland;2. University of Applied Sciences Northwestern Switzerland (FHNW), Institute of Chemistry and Bioanalytics, Muttenz, Switzerland;1. Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel;2. Coagulation Unit, Hematology Department, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel;3. Radiology Department, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel;1. IBD Center, Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy;2. IBD Center, Gastroenterology, La Source-Beaulieu, Lausanne, Switzerland;1. Department of Community Health Sciences, University of Calgary, Calgary, Canada;2. Department of Paediatrics, University of Calgary, Calgary, Canada;3. Department of Surgery, University of Calgary, Calgary, Canada;4. Department of Medicine, University of Calgary, Calgary, Canada;1. 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary;2. Institute of Psychology, Eötvös Loránd University, Budapest, Hungary;3. 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary;4. 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary |
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| Abstract: | ![]()
BackgroundOral corticosteroids remain the mainstay of treatment for moderately active ulcerative colitis (UC). In patients who fail to respond to oral corticosteroids, attempting the intravenous route before starting rescue therapies is an alternative, although no evidence supports this strategy.AimTo evaluate clinical outcomes after a course of intravenous corticosteroids for moderate attacks of UC according to the failed oral corticosteroids or not.MethodsAll episodes of active UC admitted to three university hospitals between January 2005 and December 2011 were identified and retrospectively reviewed. Only moderately active episodes treated with intravenous corticosteroids were included. Treatment outcome was compared between episodes which failed to outpatient oral corticosteroids for the index flare and those directly treated by intravenous corticosteroids.Results110 episodes were included, 45% of which failed to outpatient oral corticosteroids (median dose 60 mg/day [IQR 50–60], median length of course 10 days [IQR 7–17]). Initial response (defined as mild severity or inactive disease at day 7 after starting intravenous corticosteroids, without rescue therapy) was achieved in 75%, with no between-group differences (78% vs. 75%). After a median follow-up of 12 months (IQR 4–24), 35% of the initial responders developed steroid-dependency and up to 13% required colectomy. Unsuccessful response to oral corticosteroids was the only factor associated with steroid-dependency in the long term (P = 0.001).ConclusionsIntravenous corticosteroids are efficient for inducing remission in moderately active UC unresponsive to oral corticosteroids, but almost half of these patients develop early steroid-dependency. Alternative therapeutic strategies should be assessed in this clinical setting. |
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