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Steroids and 5-aminosalicylic acids in moderate ulcerative colitis: addressing the dilemma.
MedLine Citation:
PMID:  23320048     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Steroids have been a mainstay of ulcerative colitis (UC) therapy for many years, based on a thoroughly established efficacy profile for the induction of remission. However, in light of the considerable side effects and negative perceptions they carry, it is important to ensure such treatments are used as effectively as possible. For severe UC, the need for steroids is rarely questioned, and rightly so; it is for moderate UC that the role of steroids should be considered. Both patients and clinicians place a high importance on rapid, effective resolution of symptoms, yet at the same time wish to avoid unnecessary side effects. Through consideration of the available evidence, it becomes clear that both steroids and high-dose 5-aminosalicylic acid (5-ASA) are supported by robust trials demonstrating their efficacy. Indeed, both therapies have been shown to give rise to resolution of symptoms after 2 weeks in many patients. However, a paucity of head-to-head comparisons makes conclusive interpretation challenging. This paper therefore presents a practical approach, which builds on the available evidence and is developed from informed discussions with patients. This approach involves initiating therapy with high-dose 5-ASA, followed by a review of symptom improvements after 2-3 weeks. Steroids can then be introduced, when needed, with minimal delay. In this way, symptoms can be resolved rapidly, yet many patients may avoid unpleasant side effects.
Chris Probert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Therapeutic advances in gastroenterology     Volume:  6     ISSN:  1756-283X     ISO Abbreviation:  Therap Adv Gastroenterol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-15     Completed Date:  2013-01-16     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101478893     Medline TA:  Therap Adv Gastroenterol     Country:  England    
Other Details:
Languages:  eng     Pagination:  33-8     Citation Subset:  -    
Department of Gastroenterology, The Henry Wellcome Laboratory, Institute of Translational Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool L69 3GE, UK.
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