Description

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

 


To read more or access our algorithms and calculators, please log in or register.