Management of Crohn's Disease Exacerbation with Steroids

Steroid Selection and Efficacy

The American Gastroenterological Association recommends oral prednisone 40-60 mg/day as the first-line steroid therapy for moderate to severe Crohn's disease, while budesonide 9 mg/day is recommended for mild to moderate disease limited to the ileum and/or right colon 1, 2
For mild to moderate ileal and/or right colonic Crohn's disease, oral budesonide 9 mg/day is suggested as first-line therapy to induce remission, with response evaluation between 4-8 weeks 3, 4
In patients with moderate Crohn's disease who have failed to respond to oral budesonide 9 mg/day, prednisone 40-60 mg/day is suggested to induce complete remission 5
Oral prednisone 40-60 mg/day is strongly recommended to induce complete remission in moderate to severe Crohn's disease, with response evaluation between 2-4 weeks 1
Prednisone has been shown to induce remission in 60-83% of patients with moderate to severe Crohn's disease 1

For patients requiring repeated courses of steroids, consider steroid-sparing agents such as thiopurines, methotrexate, or biologics, with thiopurine monotherapy or methotrexate potentially used to maintain remission in selected patients [@16@, @18@, 2]
Anti-TNF therapy (infliximab, adalimumab) is recommended for patients with moderate to severe disease who fail to achieve remission with corticosteroids [@21@, 2]