Department to which work should be attributed: The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029.
Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method
Article first published online: 4 SEP 2009
© 2009 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 30, Issue 10, pages 1078–1086, November 2009
How to Cite
MURPHY, S. J., WANG, L., ANDERSON, L. A., STEINLAUF, A., PRESENT, D. H. and MECHANICK, J. I. (2009), Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method. Alimentary Pharmacology & Therapeutics, 30: 1078–1086. doi: 10.1111/j.1365-2036.2009.04136.x
- Issue published online: 20 OCT 2009
- Article first published online: 4 SEP 2009
- Publication data Submitted 26 May 2009 First decision 18 June 2009 Resubmitted 30 August 2009 Accepted 31 August 2009 Epub Accepted Article 31 August 2009
Background Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described.
Aim To assess the effectiveness of a corticosteroid withdrawal method.
Methods Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn’s disease), median age 53.5 years (range 29–75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean.
Results Median durations for disease and corticosteroid dependency were 21 (range 3–45) and 14 (range 2–45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5–73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056).
Conclusions Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.