A current overview of corticosteroid use in active ulcerative colitis

ABSTRACT

Introduction: Ulcerative colitis (UC) is a chronic inflammatory condition that causes continuous mucosal inflammation of the colon. New biological drugs have been developed in order to avoid colectomy, but corticosteroids still play a crucial role in management of active UC.

Areas covered: We reviewed the current literature about the importance of corticosteroid use in the treatment of ulcerative colitis. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence.

Expert opinion: Corticosteroids represent the mainstay of treatment in patients with severe UC and are very effective in inducing remission in mild to moderate flares not responding to combined oral and topical mesalazine. A valid alternative to systemic corticosteroids is represented by poorly absorbed steroids, such as Beclomethasone dipropionate and Budesonide MMX. In mild-moderate distal disease topical administration of corticosteroids (both systemic and BDP) is an effective alternative to topical mesalazine. However, corticosteroids do not represent a therapeutic option as a maintenance treatment since they are associated with multiple adverse effects.

KEYWORDS:

• Ulcerative colitis
• corticosteroids
• IBD
• therapy
• safety

Article highlights

• Corticosteroids represent the mainstay of treatment in patients with severe UC.

• Corticosteroids are very effective in inducing remission in mild to moderate flares not responding to combined oral and topical mesalazine treatment.

• Corticosteroids are associated with multiple adverse effects and do not represent a therapeutic option as a maintenance treatment.

• A valid alternative to systemic corticosteroids is represented by low-bioavailability steroids, such as Beclomethasone dipropionate and Budesonide MMX.

• In mild-moderate distal disease topical administration of corticosteroids (both systemic and BDP) is an effective alternative to topical mesalazine.

• Immunomodulators should be considered in corticodipendent and corticoresistant ulcerative colitis.

Declaration of interest

All authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.