title: Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Centre for Colorectal disease, St. Vincent's University Hospital, Dublin, Ireland. s.murphy@qub.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Murphy
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: L A
authors.initials: LA
authors.lastname: Anderson
authors.forename: A
authors.initials: A
authors.lastname: Steinlauf
authors.forename: D H
authors.initials: DH
authors.lastname: Present
authors.forename: J I
authors.initials: JI
authors.lastname: Mechanick
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D019966:Substance-Related Disorders; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D003907:Dexamethasone