Early Oral & Topical Anti-inflammatory Therapies for IBD
Methylprednisolone / Taro Pharmaceuticals Inc. (2021)
Ulcerative colitis–hospitalized patients with acute severe disease.
Crohn’s disease–hospitalized patients with acute severe disease.
IV
40–60 mg/24 hours.
Dosing may vary between institutions.
Hospitalized acute severe ulcerative colitis
IV 1 to 1.5 mg/kg
To a max of 60 mg/day
Divided into one or two daily doses.12
RCTs: randomized clinical trials, IV: intravenous, BDP: beclomethasone dipropionate
For more detailed information regarding side effects, please refer to the appropriate product monograph.
• Adrenal suppression
• Bone growth inhibition in pediatric population
• Mood changes
• Cushing syndrome
• Peptic ulcer
• Hyperglycemia
• Increased risk of infection
• Osteoporosis
• Glaucoma
IBD: inflammatory bowel disease
Severe ulcerative colitis should be treated with intravenous steroids.12
Recommendations15:
All available data indicate a higher risk of serious adverse events with prolonged use of corticosteroids in elderly patients with IBD when compared to younger adult patients.
Increased risk of infections, Osteoporosis-related fractures, alteration in mental status, fluid retention, ocular problems and drug interactions.
The Global Consensus Statement on the management of Pregnancy in Inflammatory Bowel Disease by Mahadevan, U. et al suggest16:
In women with IBD who are pregnant, the use of corticosteroid therapy when clinically necessary with appropriate monitoring (conditional recommendation).
The recommendations emphasize the importance of controlling disease activity before and during pregnancy with steroid sparing therapy.
Important considerations
Controlling disease activity during pregnancy among women with inflammatory bowel disease is critical to reduce adverse outcomes.
Reference studies did note with corticosteroid use there is an increased risk for preterm birth, low birth weight, gestational diabetes.
Recommendations
The Global Consensus Statement on the management of Pregnancy in Inflammatory Bowel Disease by Mahadevan, U. et al suggest16:
IBD: inflammatory bowel disease, 5-ASA: 5-aminosalicylic acid, ECCO: European Crohn’s and Colitis Organization, EEN: enteral nutrition