Conventional Medical Management of Ulcerative Colitis: Corticosteroids

Abstract

Steroid therapy has been a mainstay in the management of active ulcerative colitis for over half a century. The potency of the anti-inflammatory effect of the glucocorticoids may relate to their relatively complex mode of action with effects on pro-inflammatory cytokine production as well as inhibitory effects effector cell proliferation. In recent decades, with the introduction of immunomodulatory agents and biologic therapies, the place of steroids in the management of ulcerative colitis has changed somewhat but they are still frequently utilized in patients with moderate to severe disease and in those who do not respond to the aminosalicylates. They are rapidly effective, are comparatively inexpensive, and can be administered intravenously, orally, and topically in order to accommodate a wide variety of clinical presentations and circumstances. They are most commonly used in patients with symptoms of ulcerative colitis of moderate to severe activity. They are effective at reducing symptoms and inducing clinical remission. Steroids do have several disadvantages that have tempered their use somewhat and prompted the search for other highly effective therapies. Steroids are associated with a high prevalence of side effects, they can produce significant complications at high doses and with chronic use and, at low doses, they are not effective for maintaining remission in ulcerative colitis. Despite the fact that steroids have been used for many years for the treatment of acute ulcerative colitis, the optimal formulation, route of administration, dose and tapering schedule have not been completely worked out.