Ulcerative colitis: steroids help induce remission in active disease.

Clinical bottom line (level 1a)

  1. Patients with active ulcerative colitis who take steroids as enemas or orally are far more likely to go into remission than those on placebo.
Kornbluth et al: Journal of Clinical Gastroenterology 1993; 16 (3): 215-218
Expires May 2003

The study

Systematic review of all studies of
  • Patients: active ulcerative colitis
  • Intervention: receiving steroids for at least two weeks compared with placebo
  • Outcome: subsequent remission


    • Articles found in all languages using MEDLINE, 1967 to 1989 (search terms: 'ulcerative colitis', 'controlled trials' and 'placebo' ) and bibliographies and review articles were also searched.

    Selection criteria: as above
    Appraisal criteria: selected by two independent reviewers using set criteria (not detailed in text)
    Articles excluded if:
    • patients were allowed to continue pretrial medication
    • drugs not currently in clinical use
    • reported only in abstract form


    16 placebo-controlled trials (11 for induction of remission; 5 remission maintenance) involving 811 patients were included. Only the results of three trials are reported here.
    No test for heterogeneity

    The evidence

    incomplete remission: drug vs placebo
    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    hydrocortisone enema 15 days 8
    (88.9%)    		 1
    (10.0%)    		 89%
    (27% to 98%)    		 78.9%
    (51.2% to 107%)    		 1
    (1 to 2)
    prednisolone enema 28 days 6
    (100%)    		 1
    (16.7%)    		 83%
    (0% to 97%)    		 83.3%
    (53.5% to 113%)    		 1
    (1 to 2)
    prednisone po 28 days 15
    (83.3%)    		 6
    (31.6%)    		 62%
    (24% to 81%)    		 51.8%
    (24.7% to 78.8%)    		 2
    (1 to 4)

    Comments

    1. The paper also reported results for aminosalicylates - a more recent update has been published in the Cochrane Library.
    2. No information given on the severity of ulcerative colitis.

    Citation

    1. Kornbluth AA, Salomon P, Sacks HS, et al: meta-analysis of the effectiveness of current drug therapy of ulcerative colitis. Journal of Clinical Gastroenterology 1993; 16 (3): 215-218
    Search Terms: colit* in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient active ulcerative colitis
    Intervention or Exposure steroids
    Comparison placebo
    Outcome remission