Therapy of steroid-resistant inflammatory bowel disease.
OBJECTIVE
Although systemic corticosteroids are successfully administered for the induction of clinical response and remission in the majority of patients with inflammatory bowel disease (IBD) presenting with a flare, a proportion of these patients demonstrate a primary nonresponse to steroids or in the case of an initial response, they develop a resistance or a steroid dependence. Long-term therapy with corticosteroids for treatment of IBD should be avoided, given the high frequency of adverse treatment effects. Knowledge about treatment strategies in case of steroid nonresponse is therefore highly relevant.


METHODS
A systematic literature research was performed using Medline and Embase to summarize the currently recommended treatment strategies for steroid-resistant IBD.


RESULTS
Treatment of steroid-resistant Crohn's disease is based on the introduction of immunomodulators such as azathioprine, 6-mercaptopurine or methotrexate, the anti-TNF drugs infliximab, adalimumab and certolizumab pegol. In the case of steroid resistance in ulcerative colitis, aminosalicylates, the above-mentioned immunomodulators, infliximab, adalimumab or calcineurin inhibitors such as ciclosporin or tacrolimus may be administered.


CONCLUSIONS
This review summarizes the current evidence for treating steroid-resistant IBD.
Division of Gastroenterology and Hepatology, Claraspital, Basel, Switzerland.
Michael
M
Manz
Stephan R
SR
Vavricka
Roger
R
Wanner
Peter L
PL
Lakatos
Gerhard
G
Rogler
Pascal
P
Frei
Ekaterina
E
Safroneeva
Alain M
AM
Schoepfer
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D004351:Drug Resistance; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D060046:Maintenance Chemotherapy; D011239:Prednisolone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D011239:Prednisolone