Treatment Of Steroid-dependent Ulcerative Colitis Research Articles

Chinese herbal medicine combination therapy for patients with steroid-dependent ulcerative colitis: Study protocol for a systematic review and meta-analysis.

Background:Ulcerative colitis (UC) is a chronic non-specific intestinal inflammatory disease characterized by continuous and diffuse inflammatory response of colonic mucosa. Steroid-dependent UC is an important type of UC. Chinese herbal medicine is widely used in treating steroid-dependent UC in China. However, there is no systematic review and meta-analysis to collate and evaluate the evidence of these studies. The purpose of this research is to provide evidence of the efficacy and safety of Chinese herbal medicine in treating steroid-dependent UC.Methods and analysis:Six databases, including 3 English databases and 3 Chinese databases will be searched. In addition, other grey literatures and ongoing studies will also be searched. Two researchers will independently select eligible studies by reading titles, abstracts and full texts according to the inclusion and exclusion criteria. Risk of bias assessment will be conducted by 2 independent reviewers using Cochrane risk-of-bias tool. The outcomes include steroid-free remission rate, Total clinical effective rate, Incidence of adverse events, Disease activity index (modified Mayo score), Results of enteroscopy (Baron score) and mucosa (geboes index score). Heterogeneity between studies will be assessed by Cochrane X2 and I2 tests. We will conduct subgroup analysis and meta-regression to explore the source of heterogeneity. We will also evaluate the stability of the results through sensitivity analysis and publication bias through funnel plot and Egger test.Results:The results will be published in peer-reviewed journals.Conclusion:Our meta-analysis and systematic evaluation results will confirm whether Chinese herbal medicine is effective in the treatment of steroid-dependent UC. It will provide more ideas for future research.OSF registration number:DOI: 10.17605/OSF.IO/YP79Z

Review article: the management of steroid dependency in ulcerative colitis

Approximately 20% of patients with ulcerative colitis have a chronic active disease often requiring several courses of systemic steroids in order to achieve remission, but followed by relapse of symptoms during steroid tapering or soon after their discontinuation. Although short term control of symptoms can be achieved with steroid treatment, this pattern of drug response, known as steroid-dependency, leads to important complications of the treatment, while a significant proportion of patients requires colectomy. To review the studies currently available specifically evaluating the management of steroid-dependent ulcerative colitis. The clinical and biological mechanisms of steroid-dependency are not well understood compared with those determining steroid-refractoriness. Very few evidence-based data are available concerning the management of patients with steroid-dependent ulcerative colitis. The therapeutic role of aminosalicylates, thiopurines, methotrexate, infliximab, leukocyte apheresis and other drugs in the treatment of steroid-dependent ulcerative colitis are evaluated. Outcomes of studies in steroid-refractory patients may not be applicable to steroid-dependency. Trials are needed to define the correct approaches and new strategies to ameliorate the therapy of steroid-dependent ulcerative colitis.

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

To evaluate the efficacy of 5 compared to 10 granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis. In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption. Nine patients were randomized to 5 granulocyteaphaeresis sessions (group 1) and 11 patients to 10 granulocyteaphaeresis sessions (group 2). At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases. Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year follow-up. One serious adverse event, not related to the study therapy, was reported. Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.

Granulocyteaphaeresis in steroid‐dependent inflammatory bowel disease: a prospective, open, pilot study

Uncontrolled studies suggest that granulocyteaphaeresis might be useful in the management of active ulcerative colitis. To assess the efficacy of granulocyteaphaeresis treatment in active steroid-dependent inflammatory bowel disease. We conducted a multicentre, prospective, open, pilot study in patients with steroid-dependent inflammatory bowel disease. All patients were started on 60 mg/day of prednisone; after 1 week, a five-session programme of granulocyteaphaeresis (once per week) was started. The steroid dose was tapered weekly if there was clinical improvement. Remission was defined as an inactive clinical activity index together with complete withdrawal of steroids at week 6. The patients were followed up for at least 6 months or until disease relapse. Twenty-six patients (14 ulcerative colitis, 12 Crohn's disease) were included. More than a half had been previously treated with immunomodulators. Remission was achieved in 62 and 70% of ulcerative colitis and Crohn's disease, respectively. During a median follow-up of 12.6 months, six of eight ulcerative colitis patients maintained their clinical remission; however, only one Crohn's disease patient remained in remission after the first 6 months of follow-up. Granulocyteaphaeresis is a safe treatment option in inflammatory bowel disease. A five-session programme of granulocyteaphaeresis seems to be efficient in the treatment of steroid-dependent ulcerative colitis, but not in Crohn's disease.

Azathioprine is more effective than oral 5-ASA in the treatment of steroid-dependent ulcerative colitis

Azathioprine is more effective than oral 5-ASA in the treatment of steroid-dependent ulcerative colitis

Azathioprine is more effective than oral 5-ASA in the treatment of steroid-dependent ulcerative colitis

Azathioprine is more effective than oral 5-ASA in the treatment of steroid-dependent ulcerative colitis

A prospective, randomized trial of azathioprine monotherapy Versus Azathioprine and olsalazine for the maintenance of remission of sterold-dependent ulcerative colitis

BACKGROUND/OBJECTIVES: Since the first use of azathioprine (AZA) in the treatment of chronic ulcerative colitis (UC), there have been several open studies reporting benefit but few controlled trials. The aim of this study was to compare the efficacy of AZA and oral 5-ASA in the treatment of steroid-dependent UC.METHODS:52 patients with steroid-dependent UC (29F, 23M, mean age 42, range 18-72), were admitted to this investigator blind study. Steroiddependence was defined as a requirement of steroid therapy at -> 10 mg/day during the preceding 6 months, with at least 2 attempts to discontinue the medication. The disease had to be clinically and endoscopicelly active at study entry, and all patients were taking systemic prednisolone (40 mg/day). Patients were randomised to receive AZA 2 mg/Kg/day or oral 5ASA 3.2 g/day, for a 6-month follow-up period. Clinical and endoscopic activity was monitored by PowelI-Tuck and Baron indeces, respectively. Physician Global Assessment (PGA)(from 1 = very much improved to 6 = much worse) was evaluated after 6 months. The outcome of the treatment was defined as (1) success = induction of clinical and endoscopic remission and steroid discontinuation, (2) failure = need of at least 1 further cycle of systemic steroids to control symptoms, apart from that initial one or colectomy. RESULTS: 27 patients were treated wit AZA and 25 with 5-ASA.3 patients (1 in AZA and 2 in 5-ASA group) were lost to follow-up. After 6 months, significantly more patients in the AZA than in the 5-ASA group obtained success of therapy.Two patients in the AZA and 2 in the 5-ASA treatment groups had colectomy. PGA was b~er in AZA than in 5-ASA treatment at month 6 (AZA vs 5-ASA = 2.84_+1.75 vs 4.21_+1.80, p<O.01). CONCLUSIONS:AZA therapy is significantly more effective than 5-ASA in inducing clinical and endoscopic remission and avoiding steroid requirement in the treatment of steroid-dependent UC.

Comparison between azathioprine and oral 5-ASA in the treatment of steroid-dependent ulcerative colitis

Comparison between azathioprine and oral 5-ASA in the treatment of steroid-dependent ulcerative colitis