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Steroid-dependent Crohn's disease.

W J Sandborn1

  • 1Mayo Clinic and Mayo Foundation, Rochester, MN, USA. sandborn.william@mayo.edu

Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie
|October 7, 2000
PubMed
Summary

Corticosteroids effectively treat active Crohn's disease, but many patients become dependent or refractory. Strategies to reduce steroid use are crucial due to significant side effects associated with long-term corticosteroid therapy.

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Corticosteroids are a primary treatment for active Crohn's disease.
  • Long-term corticosteroid use is associated with significant morbidity.
  • Steroid-sparing agents are needed to minimize corticosteroid-related side effects.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of corticosteroid therapy in Crohn's disease.
  • To identify effective steroid-sparing agents for Crohn's disease management.
  • To assess strategies for reducing corticosteroid dependence and refractoriness.

Main Methods:

  • Analysis of placebo-controlled trials and population-based studies.
  • Review of patient outcomes including steroid responsiveness, dependence, and refractoriness.
  • Evaluation of various medical and surgical interventions for steroid reduction.

Main Results:

  • A significant proportion of Crohn's disease patients on corticosteroids become steroid-dependent (36%) or refractory (20%) within a year.
  • Common side effects include moon face, acne, and infections; serious long-term effects include hypertension, diabetes, and psychosis.
  • Effective steroid-sparing agents include controlled ileal release budesonide, azathioprine, 6-mercaptopurine, methotrexate, and monoclonal antibodies (CDP571, infliximab).
  • Surgical resection can reduce steroid use short-term but is associated with frequent disease recurrence.

Conclusions:

  • Reducing corticosteroid use in Crohn's disease is essential due to associated side effects and the development of dependence or refractoriness.
  • Several medical and surgical strategies can effectively spare steroids and should be routinely employed.
  • Further research into optimal steroid-sparing regimens is warranted to improve long-term patient outcomes.

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