These medicines, also known simply as steroids, are typically used orally while your medical team plans your transition to other therapies, or temporarily for very severe disease, to induce remission. They’re also used rectally in ulcerative proctitis. The American College of Gastroenterology no longer recommends steroids as a maintenance therapy to keep people in remission, however.
Steroids work to alleviate inflammation by suppressing the entire immune system. They may be taken orally, rectally, by injection, or intravenous (IV) infusion, and include the following drugs:
- budesonide (Uceris)
- prednisone
- prednisolone (Millipred)
- hydrocortisone (Cortef)
- methylprednisolone (Medrol)
Budesonide is considered a first-line treatment in some cases of moderate active UC. It can be taken orally as a tablet, or rectally, as a foam, suppository, or in an enema.
Because of the way the body processes budesonide, the oral form causes fewer side effects than other corticosteroids.
Due to their high risk of side effects, steroids other than budesonide are typically reserved for moderate to severe active UC. They also shouldn’t be taken for very long.
If you take corticosteroids orally, by injection, or IV, you may have significant side effects, because they affect the whole body. Local steroids — which are applied directly to the area that needs treatment, such as inside the rectum — are generally the preferred option.
Possible side effects of steroids include:
For severe active UC, whether it’s the first instance of significant inflammation or a flare, hospitalization and high-dose IV corticosteroids are often required. Once remission is achieved, your dose of steroids will be tapered gradually and you’ll begin taking a different class of medication for maintenance.
Although rectal steroids don’t require a period of tapering off, most short courses of steroids require some tapering. Longer courses of steroids do need to be gradually tapered off, because these medications cause the body to reduce its production of the natural steroid cortisol. Discontinuing the medication too quickly can lead to a life-threatening complication caused by the lack of cortisol, called adrenal insufficiency.
Steroids are dangerous as maintenance therapy to keep UC in remission, given the many side effects.
Once you start taking steroids, you and your doctor should also start talking about other, safer medications that may help bring this disease under control.