Steroid dependency.

Nope, your doctor is right, you are steroid dependent, even if you were off of pred for a month.  I had similar issues with pred for over 2 years and could actually taper off of it successfully for 1-2 months but then the symptoms would come back.  The next step is 6MP, which I did also.  I hope you find success with it.

Sue

Have a look at Murphy's new paper (I think Dan Present was also an author).  They came up with a new method for tapering off steroids using dexamethasone.  The protocol was highly succesful working on patients who have been steroid dependent for 2-45 yrs!  I can't remember the journal but it was published this month.

Dexamethasone??? it's more potent than prednisone. I have a friend who was put on that...I didn't even recognise her. Truly.

She lived in hell while on that stuff.

My thoughts are to avoid the steroid cycle of you can initially because there are options available as first-line topical options. Yes, oral and rectal.

quincy

     Is that the same as Methotrexate?  Not sure I have the correct spelling there.

I was steroid-dependent for two years, had a bad reaction to Imuran and was not able to go on 6-MP. Remicade infusions have been fairly helpful and got me off the Pred, but I am not facing surgery as the infusions don't last six full weeks and I don't want them more frequently.

There is no rule about having to exhaust all medication options before opting for surgery, although it is such a big (no going back) step that most people seem to want to do that first. My GI, from the very beginning, told me that the surgery was the cure and that anytime I wanted to be "done" with UC to consider that. I am ready now. If you are ready before exhausting all medication options consult a surgeon and go for it!

Meesh

Just curious of any of you steroid dependent patients....were you offered the 5ASA oral/rectal route before going on pred?

q

Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: A proposed method.

Murphy SJ, Wang L, Anderson LA, Steinlauf A, Present DH, Mechanick JI.
Department of Medicine, Daisy Hill Hospital, Newry, Northern Ireland.

Structured Summary Background: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity but methods of withdrawal are not well described. Aim: To assess the effectiveness of a corticosteroid withdrawal method Methods: IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS), and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. Results: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29-75) were included. Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years, respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in 2 patients, CWS in 5, and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (p=0.056). Conclusions: Corticosteroid withdrawal using this protocol had a high success rate and durable effect, and was effective in patients with long-standing (up to 45 years) dependency. Because symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.

Post Edited By Moderator (Admin) : 8/7/2010 10:43:02 PM (GMT-6)