title: Intravenous corticosteroids in moderately active ulcerative colitis refractory to oral corticosteroids.
abstract: BACKGROUND
  Oral corticosteroids remain the mainstay of treatment for moderately active ulcerative colitis (UC). In patients who fail to respond to oral corticosteroids, attempting the intravenous route before starting rescue therapies is an alternative, although no evidence supports this strategy.
  
  
  OBJECTIVE
  To evaluate clinical outcomes after a course of intravenous corticosteroids for moderate attacks of UC according to the failed oral corticosteroids or not.
  
  
  METHODS
  All episodes of active UC admitted to three university hospitals between January 2005 and December 2011 were identified and retrospectively reviewed. Only moderately active episodes treated with intravenous corticosteroids were included. Treatment outcome was compared between episodes which failed to outpatient oral corticosteroids for the index flare and those directly treated by intravenous corticosteroids.
  
  
  RESULTS
  110 episodes were included, 45% of which failed to outpatient oral corticosteroids (median dose 60mg/day [IQR 50-60], median length of course 10days [IQR 7-17]). Initial response (defined as mild severity or inactive disease at day 7 after starting intravenous corticosteroids, without rescue therapy) was achieved in 75%, with no between-group differences (78% vs. 75%). After a median follow-up of 12months (IQR 4-24), 35% of the initial responders developed steroid-dependency and up to 13% required colectomy. Unsuccessful response to oral corticosteroids was the only factor associated with steroid-dependency in the long term (P=0.001).
  
  
  CONCLUSIONS
  Intravenous corticosteroids are efficient for inducing remission in moderately active UC unresponsive to oral corticosteroids, but almost half of these patients develop early steroid-dependency. Alternative therapeutic strategies should be assessed in this clinical setting.
authors: Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Catalonia, Spain.
authors: Jordina
authors: J
authors: Llaó
authors: Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain.
authors: Juan E
authors: JE
authors: Naves
authors: Hospital Universitari de Bellvitge, IDIBELL (L'Hospitalet de Llobregat), Catalonia, Spain.
authors: Alexandra
authors: A
authors: Ruiz-Cerulla
authors: Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Catalonia, Spain; Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain.
authors: Laura
authors: L
authors: Marín
authors: Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain.
authors: Míriam
authors: M
authors: Mañosa
authors: Hospital Universitari de Bellvitge, IDIBELL (L'Hospitalet de Llobregat), Catalonia, Spain.
authors: Lorena
authors: L
authors: Rodríguez-Alonso
authors: Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain.
authors: Eduard
authors: E
authors: Cabré
authors: Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Catalonia, Spain.
authors: Esther
authors: E
authors: Garcia-Planella
authors: Hospital Universitari de Bellvitge, IDIBELL (L'Hospitalet de Llobregat), Catalonia, Spain.
authors: Jordi
authors: J
authors: Guardiola
authors: Hospital Universitari Germans Trias i Pujol (Badalona), CiberEHD, Catalonia, Spain. Electronic address: eugenidomenech@gmail.com.
authors: Eugeni
authors: E
authors: Domènech
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D011241:Prednisone; D008775:Methylprednisolone
keywords: Corticosteroids; Intravenous; Oral; Refractory; Ulcerative colitis