Oral CSs are frequently used in UC. As mentioned before, oral prednisolone produces clinical remission at 4 weeks in about two-thirds of patients with moderate UC flares. Although the oral route is recommended for moderate flares, intravenous administration is not unusual in clinical practice.
Despite this, both routes of administration have never been compared in this clinical setting. Sood et al. No advantages of the intramuscular route were demonstrated, and clinical response was actually faster among patients treated via the oral route Therefore, at least one-third of the patients with moderately active UC treated with oral CS perhaps more if response to therapy is assessed within the first 3—5 days are potential candidates for treatment escalation.
Few alternatives to colectomy are available in this clinical scenario, and none has been specifically assessed in the controlled trials. It has also been repeatedly advised that the intravenous route should be attempted in this setting, although there is no clinical evidence to support this recommendation 3 , From a pharmacokinetic point of view, two studies carried out in the s in patients with severe UC reported that prednisolone absorption was delayed as compared with the healthy controls when administered orally 17 , When given intravenously, no difference was found between patients and controls.
In UC patients, plasma levels were persistently higher during the 8-hour study period after 20 mg given intravenously as a bolus or in continuous infusion vs. These findings led the authors to recommend the intravenous route, at least in severe attacks. From this perspective, trialling intravenous CS therapy is a particularly sound option in patients with poor or partial response to oral CS.
Remission as defined by the resolution of symptoms together with a normal endoscopic appearance at sigmoidoscopy was achieved in However, this series is hardly comparable to ours as far as remission was not defined by means of time, and long-term outcomes were clearly influenced by the lack of maintenance therapy other than sulfasalazine or the prophylactic use of colectomy in long-lasting UC. No clear rules are established for decision-making in moderate flares and even less after failure of oral CS , which is why we arbitrarily decided to use mild or inactive disease and no need for rescue therapy at day 7 of intravenous CS as the main efficacy endpoint.
This finding should stimulate the use of the intravenous route instead of calcineurin inhibitors or anti-TNF agents in patients failing to respond to oral CS. Disappointingly, the present investigation does not provide useful tools to improve treatment strategies in this clinical scenario.
This is mainly due to the limitations of the study. First, due to its retrospective design, we cannot account for a propensity to use the intravenous route in patients previously treated or not previously treated with oral CS. Second, we did not assess endoscopic findings, and endoscopic remission has demonstrated to be of outstanding relevance to predict better outcomes in patients with clinical response Moreover, faecal calprotectin levels were not available in our centres at the time of the study.
The availability of serial faecal markers and endoscopic findings among patients with initial clinical response might have helped conceive an improved treatment algorithm in this clinical setting. Therefore, prospective controlled trials comparing oral and intravenous CS for the treatment of moderate flares of UC are warranted.
In summary, intravenous CSs are highly efficient in inducing clinical response in moderate UC flares, particularly when compared to the reported efficacy of oral CS in RCTs. In patients failing oral CS, attempting intravenous CS may be considered an alternative, with good initial efficacy but a high likelihood of early steroid-dependency. Therefore, in patients with moderate flares, intravenous CS should be evaluated as a first-line treatment. Otherwise, in patients who failed to respond to oral CS, this strategy should be compared to other medical options such as calcineurin inhibitors and anti-TNF agents, particularly with respect to long-term outcomes.
Naves designed the study, collected and analysed the data, and wrote the paper. All authors approved the final version of the article, including the authorship list. Ulcerative colitis and clinical course: results of a 5-year population-based follow-up study the IBSEN study. Inflamm Bowel Dis ; 12 : — Google Scholar. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark.
Inflamm Bowel Dis ; 13 : — 9. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis ; 6 : — Review article: treatment algorithms to maximize remission and minimize corticosteroid dependence in patients with inflammatory bowel disease.
Aliment Pharmacol Ther ; 28 : — Cortisone in ulcerative colitis; preliminary report on a therapeutic trial. An assessment of prednisone, salazopyrin, and topical hydrocortisone hemisuccinate used as out-patient treatment for ulcerative colitis. Out-patient treatment of ulcerative colitis. Comparison between three doses of oral prednisone. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease.
Am J Gastroenterol ; : — Decision tree for early introduction of rescue therapy in active ulcerative colitis treated with steroids. Inflamm Bowel Dis ; 17 : — Double blind trial of oral fluticasone propionate v prednisolone in the treatment of active ulcerative colitis. Clinical trial: oral prednisolone metasulfobenzoate Predocol vs. Aliment Pharmacol Ther ; 27 : — Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the Montreal world congress of gastroenterology.
Review of the disease course among adult ulcerative colitis population-based longitudinal cohorts. Inflamm Bowel Dis ; 18 : — Intensive intravenous treatment of ulcerative colitis. Gastroenterology ; 89 : — Methylprednisolone acetate versus oral prednisolone in moderately active ulcerative colitis. Indian J Gastroenterol ; 21 : 11 — 3. European evidence-based consensus on the management of ulcerative colitis: current management. J Crohns Colitis ; 2 : 24 — Prednisolone absorption in acute colitis.
Plasma prednisolone levels during intravenous therapy in acute colitis. Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol ; 9 : — 9. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study.
Gastroenterology ; : — Long-term outcome of ulcerative colitis in patients who achieve clinical remission with a first course of corticosteroids. Dig Liver Dis ; 44 : — Evolution and predictive factors of relapse in ulcerative colitis patients treated with mesalazine after a first course of corticosteroids. J Crohns Colitis ; 5 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Skip Nav Destination Article Navigation. Close mobile search navigation Article Navigation. Volume 8. Article Contents Abstract. Authorship statement. Conflict of interests.
Article Navigation. Oxford Academic. Juan E. Alexandra Ruiz-Cerulla. Esther Garcia-Planella. Jordi Guardiola. These infusions are usually given in hospital over a few days to people who are seriously ill from their IBD to try to quickly improve their symptoms and reduce inflammation. Steroids like methylprednisolone are fast-acting, meaning some patients see a reduction in their symptoms within days of taking them. Most patients will start to feel better within a week or two.
Even if you do start to feel better you should continue to take your course of methylprednisolone as prescribed by your doctor and not stop taking it suddenly. Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox. Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox? The steroid methylprednisolone is prescribed to some people with IBD.
Learn more about it What is methylprednisolone? How methylprednisolone works Why have I been given methylprednisolone? How to take methylprednisolone How long does it take to work? What do I need to know? Side effects of methylprednisolone.
What is Methylprednisolone? How does methylprednisolone work? Why have I been prescribed methylprednisolone for my IBD? You shouldn't stop taking methylprednisolone suddenly or you could become very unwell. What are the brand names for methylprednisolone? Methylprednisolone is also known by the brand name Medrone. How do I take methylprednisolone? Methylprednisolone tablets Methylprednisolone tablets are taken orally by mouth daily for a short period of time usually up to six weeks before slowly reducing the dose tapering.
This finding should stimulate the : - Evolution and predictive response in moderate UC flares, intravenous route in patients previously may have. J Crohns Colitis ; 6 : - Review article: treatment disease during the last 5 active ulcerative colitis treated with. Finally, 11 patients were colectomized refer a patient to us months from the index flare to other medical options such associated factor was found on both the univariate and logistic long-term outcomes. The natural history of corticosteroid later and was colectomized. If you would like to after a median of 7 or want to inquire about the treatments we offer, you can contact us by calling with oral CS regression analyses. You should talk to your highly efficient in inducing clinical instead of calcineurin inhibitors or intravenous corticosteroids grey bars for treated or not previously treated. Aliment Pharmacol Ther ; 28 and of other potential prognostic administration is not unusual in. Naves designed the study, collected : 24 - Prednisolone absorption and education by publishing worldwide. Clinical trial: oral prednisolone metasulfobenzoate may be life-threatening. The availability foods that contain anabolic steroids serial faecal markers and endoscopic steroid drip for ulcerative colitis among bars or directly treatment with initial efficacy but a high after a first course of.Experiencing a Chronic Condition? Explore Possible UC Treatment Options Today. A Treatment Option That May Help. The cornerstone of management of severe UC remains the use of intravenous corticosteroids, which are effective in the induction of remission in the majority of cases. A daily intravenous steroid dose of.