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dc.contributor.authorMurphy, S J
dc.contributor.authorWang, L
dc.contributor.authorAnderson, L A
dc.contributor.authorSteinlauf, A
dc.contributor.authorPresent, D H
dc.contributor.authorMechanick, J I
dc.date.accessioned2012-02-01T10:28:10Z
dc.date.available2012-02-01T10:28:10Z
dc.date.issued2012-02-01T10:28:10Z
dc.identifier.citationAliment Pharmacol Ther. 2009 Nov 15;30(10):1078-86. Epub 2009 Sep 4.en_GB
dc.identifier.issn1365-2036 (Electronic)en_GB
dc.identifier.issn0269-2813 (Linking)en_GB
dc.identifier.pmid19735230en_GB
dc.identifier.doi10.1111/j.1365-2036.2009.04136.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207013
dc.description.abstractBACKGROUND: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. AIM: To assess the effectiveness of a corticosteroid withdrawal method. METHODS: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29-75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. RESULTS: Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). CONCLUSIONS: Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.
dc.language.isoengen_GB
dc.subject.meshAdrenal Cortex Hormones/*adverse effects/therapeutic useen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshDexamethasone/*therapeutic useen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInflammatory Bowel Diseases/*complications/drug therapyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshSubstance Withdrawal Syndrome/*drug therapyen_GB
dc.subject.meshSubstance-Related Disordersen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleWithdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.en_GB
dc.contributor.departmentCentre for Colorectal disease, St. Vincent's University Hospital, Dublin,, Ireland. s.murphy@qub.ac.uken_GB
dc.identifier.journalAlimentary pharmacology & therapeuticsen_GB
dc.description.provinceLeinster
html.description.abstractBACKGROUND: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. AIM: To assess the effectiveness of a corticosteroid withdrawal method. METHODS: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29-75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. RESULTS: Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). CONCLUSIONS: Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.


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