Corticosteroids for the management of ulcerative colitis.

Two studies were carried out. In the first, 24 patients with severe ulcerative colitis (UC) were prospectively studied by the Research Group of Inflammatory Bowel Disease, sponsored by the Ministry of Health and Welfare of Japan. Patients were randomly assigned to two groups; one group (n = 13) was given prednisolone, 1.0 mg/kg body weight, daily, the other group (n = 11) was given prednisolone, 1.5 mg/kg body weight, daily. The 13 patients given 1.0 mg/kg prednisolone consisted of 7 with left-sided colitis and 6 with total colitis; 11 patients given 1.5 mg/kg prednisolone consisted of 5 with left-sided and 6 with total colitis. There were no statistically significant differences in clinical, endoscopic, and overall improvement between the two groups; however, 1.5 mg/kg prednisolone was significantly more effective in the treatment of the patients exhibiting the first attack. In the second study, 6 patients with severe and 7 with moderately severe UC were given megadose pulsed steroid therapy. Five hundred or 1000 mg of either hydrocortisone-21-sodium succinate or methylprednisolone was given once a day intravenously. Ten patients achieved clinical remission, 1 patient improved, and 2 patients did not respond. Endoscopically, 5 patients achieved remission, 6 patients improved, and 2 did not respond. Adverse effects severe enough to stop the medication were not noted. Steroid withdrawal syndrome also was not noted.