Crohn's disease: steroids do not clearly keep patients in remission

Clinical bottom line (level 1a-)

  1. Patients with quiescent Crohn's disease who take steroids regularly are not clearly less likely than patients on placebo to relapse.
Steinhart et al: Cochrane Library 1999; (3): -
Expires May 2003

The study

Systematic review of all randomised double-blind placebo-controlled trials of
  • Patients: patients of any age with Crohn's disease in clinical remission (CDAI < 150 or the presence of no or mild symptoms at study entry)
  • Intervention: oral conventional corticosteroid therapy (prednisone 7.5 mg daily for 3 years, prednisone 0.25 mg/kg daily for 2 years or 6-methyl-prednisolone 8 mg daily for 2 years). compared with
  • Outcome: clinical disease relapse


    • Articles found in English, French, Spanish, German and Italian using MEDline, Cochrane Controlled trials register and the inflammatory disease review groups trials register, 1966 to 1998 (search terms: MeSH terms: Crohn's disease, Inflammatory Bowel Disease and Glucocorticoid ) and manual searches of reference lists from potentially relevant articles. Proceedings from major GI meeting were hand searched from 1985 to 1997.

    Selection criteria: by 4 independent reviewers using the above criteria
    Appraisal criteria: by 2 independent reviewers using set criteria (not detailed in text)
    Articles excluded if: steroid used was budesonide or fluticasone

    3 studies found involving 754 patients
    No heterogeneity between the studies was noted.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    relapse weeks 115/386
    (29.8%)    		 0.75
    (0.54 to 1.06)     		18
    (NNT = 9 to infinity;
    NNH = 81 to infinity)

    Comments

    1. At no point during the studies (6, 12 or 24 months) did steroids have any clear effect on relapse rates.
    2. The studies contained insufficient data to comment on adverse events.
    3. There are too few studies to exclude potential benefit from using steroids.

    Citation

    1. Steinhart AH, Ewe K, Griffiths AM: corticosteroid therapy for maintenance of remission in Crohn's disease; Cochrane Review: Oxford: Update Software. Cochrane Library 1999; (3): -
    Contributor: Chris Ball and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient Crohn's disease
    Intervention or Exposure systemic steroids
    Outcome relapse, quiescence