A Controlled Trial of Alternate Day Prednisolone as a Maintenance Treatment for Ulcerative Colitis in Remission

Powell-Tuck, J; Bown, R. L.; Chambers, T.J.; Lennard‐Jones, J. E.

doi:10.1159/000198667

Cited by 61 publications

(11 citation statements)

References 18 publications

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“…Neither cortisone 50 mg daily [467] nor prednisone up to 15 mg daily [468] was effective at preventing relapse. While high-dose (40 mg) alternate-day prednisone in addition to sulfasalazine did reduce relapse rates in a small, 24-patient trial, side effects of oral corticosteroids rarely justify their long-term use [110,111,391,463,469].…”

Section: Oral Corticosteroidsmentioning

confidence: 96%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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In the US, H. pylori vacA shows allelic variation in the signal sequence (which may be type sla, slb or s2) and the mid-region (type ml or m2). Previous PCR-based vacA mid-region typing classified most, but not all, Asian and South American strains tested as ml or m2. We now sought to investigate vacA mid-region diversity further.MotlmodL We studied 13 Japanese, 6 Chinese, 9 Thai, and 8 Peruvian H. pylori isolates. cagA was identified by colony hybridisation (CH), vacA signal sequence was typed by PCR, and vacA mid-region was typed proximally by CH and distally by PCR. Sections of the vacA mid-region from 8 strains were PCR-amplified, sequenced, and compared with known sequences from 8 other strains.Rcuts Of the 36 Asian and South American strains studied, 35 were cagA+ (the cagA-was Peruvian) and 35 were vacA sla (1 cagA + Peruvian was slb). vacA mid-regions from the 13 Japanese strains were not PCR-amplified by ml or m2-specific primers, but hybridised weakly with an ml probe. Sequence analysis of vacA from 1 Japanese strain revealed 91% nucleotide identity with the ml probe but only 71% identity with the m2 probe. The previously equivocal Thai and Peruvian strains also had ml-like mid-region sequences. A Chinese strain was ml in the proximal mid-region and m2 distally, showing a clear crossover site. Final mid-region types were: Japanese, all 13 ml; Chinese, 1 ml, 1 ml/m2, 4 m2; Thai, 3 ml, 6 m2; Peruvian 4 ml, 4 m2. Distal mid-region sequences of 16 strains, compared over 294 bp, clustered into 2 groups, ml and m2. Nucleotide identity between ml and m2 strains ranged from 73-78%. Within groups, m2 strains were less diverse than ml strains (m2 range 94-99.7%, ml 88-99.3%, p<0.001). Sequence analysis of 7 ml and 3 m2 strains over 1.1kb proximally showed maintenance of clustering outside the 294bp region C duions These Asian and South American strains are similar in terms of cagA status and vacA sla genotype, but fall into 2 vacA midregion groups. ml sequences are more diverse than m2, and thus may be phylogenetically older. The vacA sequence of 1 Chinese strain suggests recombination in vivo between ml and m2 alleles. Introduction: H.pylori antimicrobial susceptibility is an important determinant ofthe efficacy of eradication therapies'. The prevalence of antimicrobial resistance varies within the UK and may increase given the increased use of eradication therapy. This multicentre study assesses the prevalence and possible associations ofH.pylon antimicrobial resistance. Methods: H.pylon was isolated from antral biopsies of patients undergoing routine endoscopy and cultured according to standard microbiological methods. Antimicrobial resistance was determined using "E-tests" or disc tests (tinidazole only) with breakpoints defined by previous studies. Results: H.pyloni was isolated from 32% (1222/3823) of patients and antimicrobial susceptibility determined in 90% (1077/1222) Previous case-control studies of IBD have used hospital or community derived controls. There are obvious inherent biases in both metho...

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Section: Oral Corticosteroidsmentioning

confidence: 96%

Inflammatory Bowel Disease

Stenson

Hanauer

Cohen

2008

Textbook of Gastroenterology

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Section: Discussionmentioning

confidence: 99%

“…1,2,20 Recent studies have shown that prednisolone is suitable as a maintenance treatment for UC in remission, although about 40 mg in an alternate-day dose is required. 20 c-GCS, when administered for either therapy of active disease or maintenance treatment of UC or CD, may lead to severe steroid side-effects. 5,21 In other studies, patients with chronic active or frequently relapsing disease have been treated with azathioprine or 6-mercaptopurine, leading to complete remission in many cases and allowing termination of therapy with corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Oral budesonide therapy for steroid‐dependent ulcerative colitis: a pilot trial

Keller¹,

Stoll²,

Foerster³

et al. 1997

Aliment Pharmacol Ther

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Background:Budesonide, a corticosteroid with high topical anti‐inflammatory activity and low systemic activity, has been shown to prolong time to relapse in Crohn's disease. In the present study, the efficacy of budesonide in an oral pH‐modified‐release formulation was evaluated for maintenance treatment in patients with steroid‐dependent ulcerative colitis.Methods:Fourteen patients with steroid‐dependent ulcerative colitis in the reduction phase of conventional glucocorticosteroids (c‐GCS) following a severe attack, were treated with budesonide 3 mg t.d.s. for 6 months. The primary investigation parameters were changes in the clinical activity index (CAI) and in the daily dose of c‐GCS.Results:In 11 cases the CAI improved significantly and treatment with c‐GCS could be terminated. Three patients experienced relapse and needed further c‐GCS treatment. The average daily dose of c‐GCS and the average value of the CAI before treatment with budesonide were significantly higher in the relapse group than in the remission group.Conclusions:In patients with c‐GCS‐dependent ulcerative colitis, a dose of 9 mg budesonide daily in an oral pH‐modified‐release formulation was well tolerated, significantly decreased the CAI, and rendered c‐GCS unnecessary in the majority of cases.

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“…Placebo-controlled studies have not been performed; however, several papers described the effect of intravenous corticosteroids in this group of patients, showing a general response rate of approximately 50% [15,16,17,18]. Contrary to their effect on the induction of remission, corticosteroids have not been shown to be beneficial for the maintenance of remission of UC [19, 20], and, together with the presence of a high frequency of side effects, currently available data do not support the use of corticosteroids for maintenance therapy.…”

Section: Currently Available Therapies For Ucmentioning

confidence: 99%

Current Pharmacologic Therapies and Emerging Alternatives in the Treatment of Ulcerative Colitis

Nakamura¹,

Nagahori

Kanai

et al. 2008

Digestion

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Recent progress in both basic and clinical research has led us to develop sophisticated and effective medical therapy of ulcerative colitis (UC). Although classical agents such as aminosalicylates, corticosteroids and immunomodulatory drugs have remained as the gold standard for decades, their novel formulations and/or dosage regimens have changed their placements in the medical management of UC. In addition, studies have shown that a number of novel therapeutic agents, designed to target specific mechanisms involved in the inflammatory cascade, have efficacy for the treatment of UC and they will have significant clinical impacts in the near future. A clear understanding of the proven and potential benefits of both the standard and emerging therapies will be required for the optimum individual care of patients with varied clinical presentations.

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A Controlled Trial of Alternate Day Prednisolone as a Maintenance Treatment for Ulcerative Colitis in Remission

Cited by 61 publications

References 18 publications

Inflammatory Bowel Disease

Inflammatory Bowel Disease

Oral budesonide therapy for steroid‐dependent ulcerative colitis: a pilot trial

Current Pharmacologic Therapies and Emerging Alternatives in the Treatment of Ulcerative Colitis

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