Two points on steroids merit, in my view, further comment.
First, although sound data are not easy to find in available literature,
the reduced systemic bioavailability of rectal prednisolone
metasulfobenzoate is probably a consequence of difficult absorption,
budesonide is a better (and very well studied (1)) example of rapid
hepatic metabolism. Moreover, the systemic effects of prednisolone
metasulfobenzoate have been shown to be substantial, at least in one study
(2).
Second, Collins and Rhodes state that 40 mg prednisolone is the optimal
dose to use based on the clinical trial performed by Baron et al. Is it
really reasonable to use the same dose for all patients? Azathioprine,
mercaptopurine, cyclosporin and tacrolimus doses are always given in
mg/kg/day. Probably the same should be done with steroids: 0.8 mg/kg/day
of prednisolone (or 1 mg/kg/day of prednisone) would be the starting
recomended dose for many clinicians with extensive experience in
ulcerative colitis.
(1) Nos P, Hinojosa J, Gomollon F, Ponce J. Budesonida en enfermedad
inflamatoria intestinal: metaanálisis. Med Clin (Barcelona) 2001; 116:47-
53.
Rapid Response:
Some points on steroids
Two points on steroids merit, in my view, further comment.
First, although sound data are not easy to find in available literature,
the reduced systemic bioavailability of rectal prednisolone
metasulfobenzoate is probably a consequence of difficult absorption,
budesonide is a better (and very well studied (1)) example of rapid
hepatic metabolism. Moreover, the systemic effects of prednisolone
metasulfobenzoate have been shown to be substantial, at least in one study
(2).
Second, Collins and Rhodes state that 40 mg prednisolone is the optimal
dose to use based on the clinical trial performed by Baron et al. Is it
really reasonable to use the same dose for all patients? Azathioprine,
mercaptopurine, cyclosporin and tacrolimus doses are always given in
mg/kg/day. Probably the same should be done with steroids: 0.8 mg/kg/day
of prednisolone (or 1 mg/kg/day of prednisone) would be the starting
recomended dose for many clinicians with extensive experience in
ulcerative colitis.
(1) Nos P, Hinojosa J, Gomollon F, Ponce J. Budesonida en enfermedad
inflamatoria intestinal: metaanálisis. Med Clin (Barcelona) 2001; 116:47-
53.
(2) Luman W, Gray RS, Pendek R, Palmer KR. Prednisolone
metasuophobenzoate foam retention enemas suppress the hypothalamo-
pituitary-adrenal axis. Aliment Pharmacol Ther 1994; 8:255-8
Competing interests:
FG is member of an advisory board of FAES-FARMA.
Competing interests: No competing interests