Efficacy for Active UC

Trials are all over 30 years old, but results are consistent: oral prednisolone (starting at 40 mg daily) induced remission in 77% of 118 patients with mild to moderate disease within 2 weeks, compared with 48% treated with 8 g/day sulfasalazine. A combination of oral and rectal steroids is better than either alone. Adverse events are more frequent with a dose of 60 mg/day compared with 40 mg/day, without added benefit; doses of prednisolone of 15 mg/day are ineffective for active disease. The optimal dose for "outpatient" management of acute UC appears to be 40 mg.

Efficacy should be balanced against side effects, but decisive treatment of active disease in conjunction with a strategy for complete withdrawal of steroids is often appreciated by patients suffering miserable symptoms. Regimens of steroid therapy vary among centres. A standard weaning strategy helps to identify patients who relapse rapidly or do not respond and need adjunctive therapy with thiop-urines or hospital admission [4].

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