Review article: appropriate use of corticosteroids in Crohn’s disease
Article first published online: 25 MAY 2007
Alimentary Pharmacology & Therapeutics
Volume 26, Issue 3, pages 313–329, August 2007
How to Cite
IRVING, P. M., GEARRY, R. B., SPARROW, M. P. and GIBSON, P. R. (2007), Review article: appropriate use of corticosteroids in Crohn’s disease. Alimentary Pharmacology & Therapeutics, 26: 313–329. doi: 10.1111/j.1365-2036.2007.03379.x
- Issue published online: 25 MAY 2007
- Article first published online: 25 MAY 2007
- Publication data Submitted 23 March 2007 First Decision 3 April 2007 Resubmitted 8 May 2007 Second decision 9 May 2007 Resubmitted 9 May 2007 Accepted 12 May 2007
Vol. 27, Issue 6, 528–529, Article first published online: 20 FEB 2008
Background Corticosteroids are a well-established treatment for active Crohn’s disease and have been widely used for decades. It has become apparent, however, that a proportion of patients either fails to respond to corticosteroids or is unable to withdraw from them without relapsing. Furthermore, their use is associated with a range of side effects, such that long-term treatment carries unacceptable risk.
Aim To review the evidence regarding the appropriate use of corticosteroids in Crohn’s disease, along with their side effects, safety and alternatives.
Methods To collect relevant articles, a PubMed search was performed from 1966 to November 2006 using the terms ‘steroid’, ‘corticosteroid’, ‘glucocorticoid’, ‘prednisolone’, ‘prednisone’, ‘methylprednislone’, ‘hydrocortisone’, ‘dexamethasone’ and ‘budesonide’ in combination with ‘Crohn(s) disease’. Relevant articles were reviewed, as were their reference lists to identify further articles.
Results When used correctly, corticosteroids are a highly effective, well tolerated, cheap and generally safe treatment for active Crohn’ disease. Nevertheless, approximately 50% of recipients will either fail to respond (steroid-resistant) or will be steroid dependent at 1 year. Newer alternatives to corticosteroids are not, however, without risk themselves and, moreover, are not necessarily available universally.
Conclusions Steroids are used widely to treat Crohn’s disease, a situation that is unlikely to change in the near future. Accordingly, efforts should be made to ensure that they are used correctly and that their side effects are minimized. Reference is made to recently published guidelines and a simplified ‘users guide’ is presented.