Early Oral & Topical Anti-inflammatory Therapies for IBD
Treatment of patients with:
Not recommended for maintenance of remission.
Treatment of patients with:
Moderate-to-severe Crohn’s disease for induction of clinical response. Should not be used as a maintenance of remission.
Oral
The recommended daily dose for oral prednisolone/prednisone is 1 mg/kg−1/day−1 (max 40 mg) once daily for 2 to 3 weeks followed by a tapering period of up to 8 to 10 weeks.
Once-daily administration of steroids in the morning is as effective as the same dose given in multiple divided doses.
Recommended daily dose for oral prednisone is 1 mg/kg/day to a maximum of 40 mg once daily for 2 to 3 weeks followed by a tapering period up to 8 to 10 weeks.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
• Hypertension
• Fluid retention
• Decreased serum potassium, sodium retention
• Arrythmias
• Mood changes
• Insomnia
• Cushingoid appearance
• Peptic ulcer
• Dyspepsia
• Gastritis
• Hyperglycemia
• Increased risk of infection
• Osteoporosis
• Avascular necrosis
• Glaucoma
IBD: inflammatory bowel disease
Oral steroids should be used as second-line treatment for mild-moderate ulcerative colitis not responding to 5-ASA (oral ± or rectal) and may be considered as first line in the higher end of the moderate disease range.
Severe ulcerative colitis should normally be treated with intravenous steroids.
Second-generation oral steroids with lower systemic effect such as BDP and budesonide-MMX (the evidence for budesonide-MMX is supportive only for left-sided colitis) may be considered in patients with mild disease refractory to 5-ASA before oral prednisolone.
Steroids are not recommended for maintaining remission; steroid-sparing strategies should be applied.12,13
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.
Coming soon
Coming soon
IBD: inflammatory bowel disease, 5-ASA: 5-aminosalicylic acid, ECCO: European Crohn’s and Colitis Organization, EEN: enteral nutrition