Review article: the management of steroid dependency in ulcerative colitis.
BACKGROUND
Approximately 20% of patients with ulcerative colitis have a chronic active disease often requiring several courses of systemic steroids in order to achieve remission, but followed by relapse of symptoms during steroid tapering or soon after their discontinuation. Although short term control of symptoms can be achieved with steroid treatment, this pattern of drug response, known as steroid-dependency, leads to important complications of the treatment, while a significant proportion of patients requires colectomy.


OBJECTIVE
To review the studies currently available specifically evaluating the management of steroid-dependent ulcerative colitis.


RESULTS
The clinical and biological mechanisms of steroid-dependency are not well understood compared with those determining steroid-refractoriness. Very few evidence-based data are available concerning the management of patients with steroid-dependent ulcerative colitis. The therapeutic role of aminosalicylates, thiopurines, methotrexate, infliximab, leukocyte apheresis and other drugs in the treatment of steroid-dependent ulcerative colitis are evaluated.


CONCLUSIONS
Outcomes of studies in steroid-refractory patients may not be applicable to steroid-dependency. Trials are needed to define the correct approaches and new strategies to ameliorate the therapy of steroid-dependent ulcerative colitis.
Bianchi Porro
G
G
Department of Clinical Science, Chair of Gastroenterology, L Sacco University Hospital, Milan, Italy. gabriele.bianchiporro@unimi.it
Cassinotti
A
A
Ferrara
E
E
Maconi
G
G
Ardizzone
S
S
D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D019317:Evidence-Based Medicine; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D012074:Remission Induction / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications* / Q000209:etiology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents