Year 1994: Corticosteroid resistance and dependence among patients with Crohn's disease

After the efficacy of systemic corticosteroids in the management of patients with ulcerative colitis was demonstrated in the 1950s (see infographic page 367), their use became widespread for treating patients with IBD. It is quite likely that corticosteroids have the honour of being the treatment that have saved the most lives in patients with IBD, but also that have affected more lives negatively due to improper use for long periods of time. In the paper we discuss now, the group coordinated by Dr Pia Munkholm of Copenhagen University Hospital describes response and clinical evolution in just over 100 patients with Crohn's disease (30 days after starting treatment and 30 days after stopping treatment) after the first cycle of systemic corticosteroids that the patients receive. The results shed light on groups of patients with potential greater difficulty in clinical management, either due to their lack of primary response to corticosteroids (20%) or relapse after discontinuation (36%), defined as steroid-dependent. In summary, just 44% of patients with Crohn's disease respond to conventional corticosteroids and maintain the response, but the rest either do not reach remission or relapse upon withdrawal of steroid treatment. We thus have two groups of patients (steroid-refractive and steroid-dependent) that are highly complex, for whom we must seek alternative treatments to achieve steroid-free remission, something that is an undeniable clinical objective today.