Corticosteroid Management for Ulcerative Colitis Flare-Ups

Introduction to Corticosteroid Options

The European Crohn’s and Colitis Organisation recommends oral prednisolone at 40 mg daily with a 6-8 week taper as the first-line corticosteroid for moderate to severe ulcerative colitis flares 1, 2
For mild to moderate UC flares, 5-ASA (mesalazine) therapy should be optimized first at doses of 2-4 g/day orally, ideally combined with topical 5-ASA therapy 1, 2

Single daily dosing of prednisolone is as effective as split-dosing and causes less adrenal suppression 1
Topically-acting oral corticosteroids, such as budesonide MMX 9 mg/day for 8 weeks or beclomethasone dipropionate 5 mg/day for 4 weeks, can be considered for patients wishing to avoid systemic corticosteroids 2, 1, 3, 4

Approximately 50% of patients experience short-term corticosteroid-related adverse events, such as acne, edema, sleep disturbance, mood changes, glucose intolerance, and dyspepsia 1
Corticosteroids should be tapered gradually over 6-8 weeks to minimize risk of relapse 1, 7
Patients requiring two or more courses of corticosteroids in the past year, or who become corticosteroid-dependent, require treatment escalation with thiopurines, anti-TNF therapy, vedolizumab, or tofacitinib 1, 2

In patients with moderate to severe symptoms suggestive of flare, fecal calprotectin >150 mg/g, elevated fecal lactoferrin, or elevated CRP can be used to confirm active inflammation and guide treatment decisions 8
Endoscopic assessment may be necessary in patients with mild symptoms and elevated inflammatory markers before treatment adjustment 8