In general, they are recommended only for active Crohn's, because long-term treatments cause significant side effects and alternative drugs exist. Unfortunately, most doctors also use them for maintenance treatment, in spite of the fact that two major analyses of oral steroids reported no reduction in relapse rates with their use.
Patients who are malnourished are less likely to respond to steroids, and those who had an initial inadequate response to steroids are also less likely to do well with repeat therapy. Some patients who have had Crohn's disease for a long time may have partial or complete resistance to corticosteroids.
Corticosteroid Types. Prednisone, prednisolone, hydrocortisone, and methylprednisolone are the most common corticosteroids. Newer steroids, such as budesonide, fluticasone, beclomethasone, dipropionate, prednisolone-21-methasulphobenzoate, and tixocortol, affect only local areas in the intestine and do not circulate throughout the body. Such drugs may avoid the widespread side effects that are a serious problem with long-term treatment using the older conventional steroids. Recent studies suggest that budesonide can help prolong and maintain remission periods in patients with Crohn’s disease.
Administering Corticosteroids. Steroids can be taken orally, intravenously, by injection, or rectally as a suppository, enema, or foam. The severity or location of the condition often determines the form.
In general, oral preparations are used for moderate to severe Crohn's disease. Delayed-release forms of corticosteroids, such as beclomethasone or budesonide, affect only local areas of the intestine and may be useful for mild to moderate Crohn's disease without causing systemic side effects.
If the patient requires hospitalization, intravenous steroid therapy is administered initially. (If these drugs are not effective after a week of intravenous therapy, they are not likely to work.)
Side Effects of Corticosteroids. Standard steroids can have distressing and sometimes serious long-term side effects, including:
Previous Section
