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
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