From the Guidelines
For an acute Crohn's disease flare, prednisone is typically prescribed at a dose of 40-60 mg daily for moderate to severe flares, as recommended by the Canadian Association of Gastroenterology clinical practice guideline for the management of luminal Crohn's disease 1. The treatment usually begins with this higher dose and continues for 1-2 weeks until symptoms improve, followed by a gradual taper over 8-12 weeks, reducing by 5-10 mg weekly.
- Budesonide is an alternative option for mild to moderate flares, particularly those affecting the ileum or right colon, given at 9 mg daily for 8-12 weeks with a subsequent taper, as suggested by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1.
- During steroid therapy, patients should take calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplements to prevent bone loss.
- Proton pump inhibitors may be added to reduce gastrointestinal side effects.
- It's essential to monitor for steroid-related complications, including mood changes, insomnia, hyperglycemia, and hypertension, as highlighted in the Canadian Association of Gastroenterology clinical practice guideline for the management of luminal Crohn's disease 1.
- Steroids provide quick symptom relief by reducing inflammation through inhibition of inflammatory mediators, but they are not suitable for long-term maintenance therapy due to significant side effects.
- A gastroenterologist should be consulted to develop a maintenance plan with steroid-sparing agents to prevent future flares.
From the Research
Recommended Steroid Dose for Acute Crohn's Disease (CD) Flare
- The recommended steroid dose for an acute Crohn's disease (CD) flare is not explicitly stated in the provided studies, but the studies suggest the following doses:
- Methylprednisolone 40 mg/day i.m. for 3 weeks, followed by a tapering dosage 2
- Budesonide 9 mg/day, which is equivalent to systemically active glucocorticosteroids in achieving disease remission 3
- Budesonide controlled ileal release (CIR) capsules 9 mg once daily or 4.5 mg twice daily, which is comparable to prednisolone 40 mg once daily 4
- Oral pH-modified release budesonide 3 x 3 mg/day, which is almost as effective as a conventional corticosteroid in patients with active CD 5
Comparison of Steroid Regimens
- A study comparing two steroid regimens of different duration found no significant differences in remission rates between the two regimens 2
- Another study comparing post-hospitalization short versus long steroid taper strategies in patients with acute severe ulcerative colitis found that both regimens showed comparable clinical results 6