Everything old is new again? A fresh look at corticosteroids in ulcerative colitis

Corticosteroid therapy remains a mainstay in the treatment of active ulcerative colitis. While useful in the induction of remission, corticosteroids should be avoided for maintenance therapy because of lack of efficacy and serious short- and long-term side effects. Bone fracture risk is increased with as little as 3 months of therapy so that safer corticosteroid therapies would have a significant impact. In this issue of American Journal of Gastroenterology, the treatment of mild to moderate ulcerative colitis with dexamethasone 21-P encapsulated erthryocytes (DEE), a novel method of corticosteroid drug delivery, is described. The results suggest similar efficacy as conventional oral corticosteroids with significantly decreased short-term corticosteroid-related side effects. This study was small and follow-up was limited, but the findings are intriguing. These results should prompt further study of this method of drug delivery to confirm efficacy, assess short-term and possibly long-term side effect, and determine whether this translates into better overall safety.