From the Guidelines
Prednisone should be initiated for patients with ulcerative colitis when they have moderate to severe disease activity that has not responded to first-line therapies such as 5-aminosalicylates (5-ASAs). The decision to start prednisone is based on the severity of the disease and the patient's response to initial treatment. According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1, patients with mild to moderate ulcerative colitis should be managed with oral 5-ASA 2–3 g/day, and prednisolone should be used when 5-ASA induction therapy fails or is not tolerated.
Key Considerations
- The typical starting dose of prednisone is 40-60mg daily, taken orally as a single morning dose, with a gradual taper over 8-12 weeks to minimize steroid dependency and withdrawal symptoms 1.
- Before starting prednisone, it's essential to screen for contraindications including uncontrolled diabetes, active infections, or psychiatric disorders.
- During treatment, patients should be monitored for side effects including hyperglycemia, hypertension, mood changes, and insomnia.
- Calcium and vitamin D supplementation should be provided to prevent bone loss.
Alternative Treatments
- Topically-acting oral corticosteroids such as budesonide MMX 1 and beclomethasone dipropionate can be used as alternative treatments for those wishing to avoid systemic corticosteroids.
- The optimal dose and dosing regimen for systemic corticosteroids in UC is uncertain, but based on a meta-analysis reporting no evidence of benefit with dosages higher than 60 mg/day, the consensus group agreed with the commonly used regimen of oral prednisone 40 to 60 mg/day (or equivalent) 1.
Monitoring and Maintenance
- Patients should be closely monitored for signs of remission and potential side effects.
- Prednisone should be considered a bridge therapy while initiating steroid-sparing maintenance medications, as long-term steroid use carries significant risks 1.
From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required The initial dosage should be maintained or adjusted until a satisfactory response is noted.
The FDA drug label does not answer the question.
From the Research
Initiating Prednisone in Ulcerative Colitis Patients
- The decision to start a patient with ulcerative colitis on prednisone depends on the severity of the disease and the patient's response to other treatments 2, 3.
- For patients hospitalized with moderate-severe flares, methylprednisolone 40-60 mg intravenous every 24 hours or hydrocortisone 100 mg intravenous 3 times daily is appropriate for inpatient management 2.
- It is appropriate to discharge patients on 40 mg of prednisone after observing patients for 24 hours in hospital to ensure stability before discharge 2.
- The use of corticosteroids, such as prednisone, is a common treatment approach for inducing clinical remission in patients with ulcerative colitis 4.
Considerations for Prednisone Treatment
- The treatment of ulcerative colitis with steroids, including prednisone, should be individualized based on the patient's disease severity, medical history, and response to previous treatments 3, 4.
- Patients with acute severe ulcerative colitis may require more aggressive treatment, including intravenous corticosteroids and/or biologic therapies 5.
- The efficacy and safety of medical treatments for acute severe ulcerative colitis, including prednisone, have been evaluated in several studies 5.