Withdrawal of steroids in IBD patients after to 45 years: a proposed method

[Mark in Seattle]

fyi - might be worth a discussion with your GI if you ever need a strategy for coming off prednisone and your IBD is quiescent.


Aliment Pharmacol Ther. 2009 Nov 15;30(10):1078-86. doi: 10.1111/j.1365-2036.2009.04136.x. Epub 2009 Sep 4.
Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.Murphy SJ, Wang L, Anderson LA, Steinlauf A, Present DH, Mechanick JI.
SourceCentre for Colorectal disease, St. Vincent's University Hospital, Dublin, Ireland. s.murphy@qub.ac.uk

Abstract
BACKGROUND: 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.

PMID:19735230[PubMed - indexed for MEDLINE]

 

[rollinstone]

Iv been on pred for 4 months now, hoping to ween off okay :/

 

[Susan2]

I was on Prednisolone for 25 years (nothing much else around and what there was - sulphasalazine and flagyl - didn't have any effect on my Crohn's) and I had no difficulty coming off it after my proctocolectomy.

 

[Mark in Seattle]

Thanks Susan2. That is a good insipirational piece of info to learn from you about weaning after 25 years.

I've been on prednisone for about 1.5 years now although never at super high doses. My biggest problem is that I get massive inflammation if I attempt to lower my dose below 12mg, so I tend to stay right around 12mg. Another observation I've made is that when I attempt to lower my dose, I become really prone to anxiety attacks. And I am able to notice what sets me off. Most often it's something I eat. Like if I take a bite of food with a tiny bit of spicy salsa on it, or take a sip of tea that might have a slight tang to it, it's as though I get a little shot of adrenaline which sets my body into anxiety mode. Somehow my body is really on edge and easy to go into fight/flight mode when tapering. I've never been on pred as long as this time so I'm hoping I can come off some day. My GI continually tells me it's not "if" I'll have serious problems due to prednisone, but "when".

 

[UnXmas]

Does this mean everyone who takes these steroids for a certain time becomes dependent? I know everyone has to taper slowly, but is that just a precaution?