Papi et al evaluated the response of patients with Crohn's disease to corticosteroid therapy. They classified the response shown by the patient during and after the steroid therapy The authors are from hospitals in Rome and Bari, Italy.
Patient selection - Crohn's disease with:
(1) first course of corticosteroid therapy
(2) clinical remission achieved with an oral dose of 0.8 to 1.0 mg prednisone per kg per day
(3) gradual tapering of corticosteroid dose over 12 to 16 weeks
(4) maintenance on oral aminosalicylic acid 2.4 to 4.0 grams per day
Followup: up to 12 months after corticosteroid therapy
Classification |
Features |
steroid refractory |
failure to respond to oral dose of corticosteroid within 3 weeks |
steroid dependent |
EITHER 2 consecutive early relapses during corticosteroid weaning period OR relapse within 4 weeks of corticosteroid withdrawal (early relapse) |
steroid-induced remission |
complete clinical remission at 4 weeks after discontinuation of corticosteroid therapy |
clinical relapse |
recurrence of symptoms after achieving remission |
where:
• A remission was defined as the CDAI (see above) < 150.
• If a relapse occurred while weaning then the dose was adjusted to achieve control.
Relapse |
Features |
mild |
further corticosteroid therapy not required |
moderate |
oral corticosteroid therapy required |
severe |
hospitalization with intensive intravenous corticosteroid therapy |
Specialty: Gastroenterology