From the Guidelines
For a Crohn's disease flare, the initial recommended dose of prednisone is typically 40 mg per day, tapering by 5 mg weekly, as this approach is effective in inducing remission while minimizing side effects. This dose is often used for mild, moderate, and severe colonic Crohn’s disease, as stated in the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1. The Canadian Association of Gastroenterology clinical practice guideline for the management of luminal Crohn's disease also suggests the use of prednisone 40–60 mg/day to induce complete remission in patients with moderate to severe Crohn’s disease 1.
Key considerations for the use of prednisone in Crohn's disease flares include:
- Starting with a dose of 40 mg per day, which can be adjusted based on disease severity and patient tolerance
- Tapering the dose by 5 mg weekly to minimize side effects and reduce the risk of relapse
- Limiting the total duration of steroid therapy to 8-12 weeks when possible to minimize side effects
- Monitoring patients for symptomatic response to prednisone and adjusting therapy as needed
- Considering alternative therapies, such as ileal-release budesonide, for patients with less severe symptoms or those who are intolerant to prednisone 1.
It is essential to weigh the benefits of prednisone against its potential side effects, including weight gain, mood changes, increased infection risk, and osteoporosis, and to consider calcium and vitamin D supplementation to prevent bone loss during treatment.
From the Research
Initial Dose of Prednisone for Crohn's Disease Flare
- The initial dose of prednisone for a Crohn's disease flare is typically in the range of 1 mg/kg body weight per day, as seen in a study published in 1990 2.
- Another study from 1998 suggests that 1 mg/kg a day of oral prednisolone given for 3 to 7 weeks can achieve clinical remission in 92% of patients 3.
- A specific dose of 40 mg per day for two weeks, followed by a gradual reduction, has also been used in clinical trials, as reported in a 1994 study comparing budesonide with prednisolone for active Crohn's disease 4.
Comparison of Corticosteroids
- Budesonide, a topical acting oral corticosteroid, has been shown to have fewer glucocorticoid-associated side effects and less suppression of pituitary-adrenal function compared to prednisolone 4.
- The efficacy of budesonide in mild and moderate flare-ups of Crohn's disease is promising, but its indication in severe disease alongside high-dose prednisolone needs further clarification 3.
Treatment Duration and Maintenance
- Treatment with prednisone is usually maintained until clinical remission is achieved, and for at least 3 and at most 7 weeks 2.
- Alternate-day prednisone treatment and maintenance have been shown to be a reasonable treatment option for patients with Crohn's disease not responsive to sulfasalazine alone, with 60% of patients showing favorable responses 5.