Evidence-based On-call

Inflammatory bowel disease

Therapy

Withdraw steroids gradually once clinical symptoms and inflammatory markers are improving. ^a

Do not reduce the dose based on colonoscopic signs alone. ^a

Why?

Fewer patients fail to achieve remission or relapse when steroids are reduced on the basis of symptoms and inflammatory markers, but more remain on steroids. ^a
Continuing steroid therapy in asymptomatic patients with active lesions on colonoscopy increases steroid adverse effects without preventing relapse. ^a

Steroid tapering using symptoms and inflammatory markers prevents failure to achieve remission or relapse

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
inflammatory bowel disease ^a	steroid tapering based on symptoms and orosomucoid levels	steroid tapering based on symptoms alone	stopped steroids at 12 months	63%	-61% (-78% to -31%)	-3 (-5 to -2)
			failure to achieve remission or relapse at 12 months	61%	56% (24% to 74%)	3 (2 to 7)

Crohn's disease: treating asymptomatic lesions on colonoscopy leads to steroid adverse effects

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
asymptomatic Crohn's on steroids with active lesions on colonoscopy ^a	continuing steroids for 5 weeks	immediate steroid tapering	steroid adverse effects at 5 weeks	22%	-140% (-350% to -25%)	-3 (-9 to -2)