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. 2000;2003(2):CD000301.
doi: 10.1002/14651858.CD000301.

Corticosteroids for maintaining remission of Crohn's disease

A H Steinhart  1 , K Ewe, A M Griffiths, R Modigliani, O O Thomsen
Affiliations

Corticosteroids for maintaining remission of Crohn's disease

A H Steinhart et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Objectives: To evaluate the effectiveness and safety of conventional systemic corticosteroid therapy in maintaining clinical remission in Crohn's disease.

Search strategy: A computer-assisted search of the on-line bibliographic database MEDLINE of studies published in English, French, Spanish, Italian and German between 1966 and May, 1998. Manual searches of the reference lists from the potentially relevant studies were performed in order to identify additional studies that may have been missed using the computer-assisted search strategy. Proceedings from major gastrointestinal meetings were also manually searched from 1985 to 1997 in order to identify unpublished studies. The Cochrane Controlled Trials Register and the Inflammatory Bowel Disease Review Group Trials Register were also searched.

Selection criteria: Randomized double-blind placebo-controlled trials involving patients of any age with Crohn's disease in clinical remission as defined by a CDAI < 150 or by the presence of no symptoms or only mild symptoms at the time of entry into the trial. The experimental treatment consisted of oral conventional corticosteroid therapy (excluding budesonide, fluticasone, etc). Clinical disease relapse was used as the outcome measure of interest.

Data collection and analysis: Eligible studies were selected by 4 reviewers and data were extracted onto standardized data extraction forms. Disagreements in eligibility or data extraction were resolved by consensus. Data were converted into individual 2x2 tables for each study. The presence of significant heterogeneity among studies was tested using the chi-square test. The 2x2 tables were synthesized into a summary test statistic using the pooled odds ratio and 95% confidence intervals as described by Cochran and Mantel and Haenszel (the 'odds ratio' in MetaView). A fixed effects model was used for the pooling of data.

Main results: Four studies were initially judged as being eligible for inclusion. After obtaining additional information on one of the studies it was excluded because it was not double-blind. The total number of subjects included in the analysis at the time points of 6, 12 and 24 months were 142, 131 and 95 for the corticosteroid group and 161, 138 and 87 for the control group. The odds ratios for relapse on active treatment and the corresponding 95% confidence intervals were 0.71 (0.39, 1.31), 0.82 (0.47, 1.43) and 0.72 (0.38, 1.35) at 6, 12 and 24 months. The numbers needed to treat with corticosteroids to prevent one additional relapse were 24, 35, 15 respectively.

Reviewer's conclusions: The use of conventional systemic corticosteroids in patients with clinically quiescent Crohn's disease does not appear to reduce the risk of relapse over a 24 month period of follow-up.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Corticosteroid versus Placebo, Outcome 1 Relapse.
See this image and copyright information in PMC

References

References to studies included in this review

ECCDS 1984 {published data only}
    1. Malchow H, Ewe K, Brandes JW, Goebell H, Ehms H, Sommer H, et al. European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology 1984;86(2):249‐266. - PubMed
NCCDS 1979 {published data only}
    1. Summers RW, Switz DM, Sessions JT Jr, Becktel JM, Best WR, Kern F Jr, et al. National Cooperative Crohn's Disease Study: results of drug treatment. Gastroenterology 1979;77(4 Pt 2):847‐69. - PubMed
Smith 1978 {published data only}
    1. Smith RC, Rhodes J, Heatley RV, Hughes LE, Crosby DL, Rees BI, et al. Low dose steroids and clinical relapse in Crohn's disease: a controlled trial. Gut 1978;19(7):606‐10. - PMC - PubMed

References to studies excluded from this review

Bergman 1976 {published data only}
    1. Bergman L, Krause U. Postoperative treatment with corticosteroids and salazosulphapyridine (Salazopyrin) after radical resection for Crohn's disease. Scand J Gastroenterol 1976;11(7):651‐6. - PubMed
Brignola 1988 {published and unpublished data}
    1. Brignola C, Campieri M, Farruggia P, Tragnone A, Pasquali S, Iannone P, et al. The possible utility of steroids in the prevention of relapses of Crohn's disease in remission. A preliminary study. J Clin Gastroenterol 1988;10(6):631‐4. - PubMed
Fiasse 1980 {published data only}
    1. Fiasse R, Pringot J, Melange M, Heuverzwijn R, Goncette L, Mahieu P, et al. Crohn's disease with predominant lesions in the colon. Prospective long term study of a treatment combining corticosteroids and sulfasalazine with or without azathioprine. Acta Gastroenterol Belg 1980;43(9‐10):410‐28. - PubMed
Gorard 1993 {published data only}
    1. Gorard DA, Hunt JB, Payne‐James JJ, Palmer KR, Rees RG, Clark ML, et al. Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone. Gut 1993;34(9):1198‐202. - PMC - PubMed
Landi 1992 {published data only}
    1. Landi B, Anh TN, Cortot A, Soule JC, Rene E, Gendre JP, et al. Endoscopic monitoring of Crohn's disease treatment: a prospective, randomized clinical trial. The Groupe d'Etudes Therapeutiques des Affections Inflammatoires Digestives. Gastroenterology 1992;102(5):1647‐53. - PubMed

Additional references

Chalmers 1981
    1. Chalmers TC, Smith H Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, et al. A method for assessing the quality of a randomized controlled trial. Control Clin Trials 1981;2(1):31‐49. - PubMed
Modigliani 1996
    1. Modigliani R, Colombel JF, Dupas JL, Dapoigny M, Costil V, Veyrac M, et al. Mesalamine in Crohn's disease with steroid‐induced remission: Effect on steroid withdrawal and remission maintenance. Gastroenterology 1996;110(3):688‐93. - PubMed
Munkholm 1994
    1. Munkholm P, Langholz E, Davidsen M, Binder V. Frequency of glucocorticoid resistance and dependency in Crohn's disease. Gut 1994;35(3):360‐2. - PMC - PubMed
Pearson 1995
    1. Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6‐mercaptopurine in Crohn's disease. A meta‐analysis. Ann Intern Med 1995;123(2):132‐42. - PubMed
Pearson 1998
    1. Pearson DC, May GR, Fick G, Sutherland LR. Azathioprine for maintenance of remission in Crohn's disease. Cochrane Database of Systematic Reviews 1998, Issue 4. [Art. No.: CD000067. DOI: 10.1002/14651858.CD000067] - PubMed
Sandborn 1998
    1. Sandborn W, Sutherland L, Pearson D, May G, Modigliani R, Prantera C. Azathioprine or 6‐mercaptopurine for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 1998, Issue 3. [Art. No.: CD000545. DOI: 10.1002/14651858.CD000545] - PubMed

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