Area Editoriale
BACKGROUND:In patients with severe attacks of ulcerative colitis (UC), IV steroidsrepresent the first-line treatment, leading to clinical improvement inapproximately 50-60% of patients. AIM: The aim of this study was toprospectively compare the efficacy and safety of different modalities ofsteroid administration, and to evaluate predictors of failure to therapy.MATERIALS In a single-center, double-blind trial, consecutive patients with asevere attack of UC received AND METHODS: 1 mg/kg/day of 6-methyl-prednisoloneadministered randomly by either a bolus injection (group A) or continuousinfusion (group B). RESULTS: Sixty-six patients were enrolled (35 men, mean age38 +/- 15, range 18-75 yr), 15 of them at their first attack of UC; in theremaining cases, the mean duration of disease was 4.5 +/- 5 yr. At inclusion,forty patients (60%) had pancolitis and the remainder had left-sided colitis.Overall, thirty-three patients (50%) underwent clinical remission after 7 daysof treatment: 16 of 32 ingroup A and 17 of 34 ingroup B. Thirty-one patients eventually underwent total colectomy (12 in group A and 9 in group B), which wascarried out by the first month in 10 patients (5 in each group). Twenty-eightpatients (15 ingroup A and 13 ingroup B) experienced steroid-related adverse reactions. All differences betweengroups were not statistically significant. Previous use of steroids (OR 13.6,CI 2-86) and active smoking (OR 11.6, CI 1.4-107) were independent predictorsof nonresponse. CONCLUSIONS: In severe attacks of UC, methyl-prednisolone givenas a continuous infusion was no better than bolus administration in terms ofefficacy and safety.Leggil'articolo