| Summary: | Placebo controlled trials
have demonstrated that a tapering course of corticosteroids is
an effective therapy for active Crohn’s disease. A populationbased
study of 109 patients with Crohn’s disease undergoing their
first course of corticosteroids showed that, at the end of one year,
44% of patients were steroid responsive, 36% were steroid dependent
and 20% were steroid refractory. Side effects occur frequently
during a four-month tapering course of corticosteroids, including
moon face, acne, infection, ecchymoses, hypertension, hirsutism,
petechial bleeding and striae. More serious side effects occur with
long term use, including hypertension, diabetes, infection, osteonecrosis,
osteoporosis, myopathy, cataracts, glaucoma and psychosis.
Low dose corticosteroids, alternate-day corticosteroids and mesalamine
(5-aminosalicylate) are not effective steroid-sparing
agents in patients with Crohn’s disease. Controlled ileal release
budesonide, 6 mg/day, is an effective steroid-sparing agent, but it
does result in some decrease in adrenal function. Azathioprine,
6-mercaptopurine and methotrexate are all effective steroidsparing
agents, as is the humanized, anti-tumour necrosis factor
monoclonal antibody, CDP571. A preliminary, uncontrolled
study has suggested that the mouse/human chimeric monoclonal
antibody infliximab may also be steroid sparing. Surgical resection
is an effective strategy to reduce steroid use in the short to intermediate
term, but postoperative reoccurrence of Crohn’s disease occurs
frequently. Given the morbidity associated with prolonged
corticosteroid use, medical and surgical treatment strategies to reduce
steroid use should be employed routinely.
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