Predictors of repeat steroid course with Crohn's disease identified

April 13, 2007 — Up to 35% of patients who achieve steroid-induced remission of Crohn's disease will require additional steroid treatment within 1 year, Italian researchers report. Elevated C-reactive protein levels at steroid weaning and penetrating complications may help predict the need for further steroid therapy.

While corticosteroids are considered the gold standard treatment for moderate-to-severe Crohn's disease, they can cause severe side effects and disease relapses are common, lead author Dr. Claudio Papi, from the S. Filippo Neri Hospital in Rome, and colleagues note.

The focus of the present study, which is reported in the American Journal of Gastroenterology for April, was to assess the likelihood of requiring additional steroid therapy after achieving steroid-induced remission and to identify relevant clinical predictors.

The study involved 77 patients with steroid-induced remission, defined as a Crohn's Disease Activity Index < 150 at 4 weeks after steroid weaning, who were followed for 12 months. Complete data were available for 75 of the patients.

Overall, 65.3% of patients experienced no relapse or mild relapse and 34.6% had moderate or severe relapse that required a repeat course of steroids, the report indicates. The cumulative probability of a steroid-free course was 93.3%, 82.6%, 78.6%, and 66.6% at 3, 6, 9, and 12 months, respectively.

Of the 77 patients, 18 had penetrating disease: perianal disease in 12 and internal fistula in 6.

After adjusting for age, gender, disease location, and other potential confounders, an elevated C-reactive protein level at steroid weaning and penetrating complications emerged as independent predictors of a further steroid course, raising the risk by 5.57- and 4.20-fold, respectively.

"Although our study is limited in its retrospective design, it is an attempt to identify factors predictive of high corticosteroid requirements in patients with an initial clinical response," the authors state. "A prospective cohort study would offer the possibility of identifying patients at high risk of repeated corticosteroid courses, thus allowing better selection of patient candidates to an early introduction of immunosuppressive agents, even at their first steroid course."