Use of systemic corticosteroids in therapy of intestinal inflammatory diseases (Literature review)

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Abstract

High anti-inflammatory activity of systemic corticosteroids (CS) determines their continuing actuality in the treatment of inflammatory bowel diseases (IBD). However, serious adverse events and the development of resistance often neutralize the expected therapeutic effect of these drugs, which requires strict adherence to indications, dosing regimens and duration of their use. At the same time, clear criteria and generally accepted recommendations for the use of CS in versatile clinical practice have not been developed yet. Foreign clinical guidelines for IBD treatment have a wide range of systemic CS doses and various methods for their calculation, based on foreign studies of a fairly low level of evidence, performed quite a long time ago, and also recommended based on a fairly large experience of their use. In Russian guidelines, the proposed doses of systemic CS are higher than in foreign ones, but they are also based on empirical expert assessments. Dose-response studies of CS in patients with IBD have never been made.

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About the authors

Diana I. Abdulganieva

Kazan State Medical University of the Ministry of Healthcare of Russia

Author for correspondence.
Email: Diana.Abdulganieva@kazangmu.ru
ORCID iD: 0000-0001-7069-2725

MD, professor, head of the Department of hospital therapy

Russian Federation, 420012, Kazan, 49 Butlerova Str.

Anastasia A. Alekseeva

Privolzhsky Research Medical University of the Ministry of Healthcare of the Russia

Email: anastasyalekseeva1998@mail.ru
ORCID iD: 0000-0001-5161-6436

2nd year resident of the Department of hospital therapy and general medical practice named after V.G. Vogralik

Russian Federation, 603005, Nizhny Novgorod, 10/1 Minina i Pozharskogo Sq.

References

  1. Selinger C.P., Parkes G.C., Bassi A. et al. Assessment of steroid use as a key performance indicator in inflammatory bowel disease-analysis of data from 2385 UK patients. Aliment Pharmacol Ther. 2019; 50(9): 1009–18. https://dx.doi.org/10.1111/apt.15497.
  2. Seow C.H., Coward S., Kroeker K.I. et al. Declining corticosteroid use for inflammatory bowel disease across alberta: A population-based cohort study. J Can Assoc Gastroenterol. 2022; 5(6): 276–86. https://dx.doi.org/10.1093/jcag/gwac021.
  3. Okayasu M., Ogata H., Yoshiyama Y. Use of corticosteroids for remission induction therapy in patients with new-onset ulcerative colitis in real-world settings. J Mark Access Health Policy. 2019; 7(1): 1565889. https://dx.doi.org/10.1080/20016689.2019.1565889.
  4. Князев О.В., Белоусова Е.А., Абдулганиева Д.И. с соавт. Реальная практика лекарственной терапии среднетяжелых и тяжелых форм воспалительных заболеваний кишечника в России, Республике Беларусь и Республике Казахстан. Промежуточные результаты исследования INTENT. Альманах клинической медицины. 2021; 49(7): 443–454. [Knyazev O.V., Belousova E.A., Abdulganieva D.I. et al. The real practice of drug therapy of moderate and severe forms of inflammatory bowel diseases in Russia, the Republic of Belarus and the Republic of Kazakhstan. Interim results of the INTENT study. Al’manakh klinicheskoy meditsiny = Almanac of Clinical Medicine. 2021; 49(7): 443–454 (In Russ.)]. https://dx.doi.org/10.18786/2072-0505-2021-49-061. EDN: RAOOTK.
  5. Белоусова Е.А., Шелыгин Ю.А., Ачкасов С.И. с соавт. Клинико-демографические характеристики и лечебные подходы у пациентов с воспалительными заболеваниями кишечника (болезнь Крона, язвенный колит) в РФ. Первые результаты анализа национального Регистра. Колопроктология. 2023; 22(1): 65–82. [Belousova E.A., Shelygin Yu.A., Achkasov S.I. et al. Clinical and demographic characteristics and therapeutic approaches in patients with inflammatory bowel diseases (Crohn’s disease, ulcerative colitis) in the Russian Federation. The first results of the analysis of the national Register. Koloproktologiya = Coloproctology. 2023; 22(1): 65–82 (In Russ.)]. https://dx.doi.org/10.33878/2073-7556-2023-22-1-65-82. EDN: IMBCQN.
  6. Насонов Е.Л. Общая характеристика и механизмы действия глюкокортикоидов. РМЖ. 1999; (8): 4. [Nasonov E.L. General characteristics and mechanisms of action of glucocorticoids. Russkiy meditsinskiy zhurnal = Russian Medical Journal. 1999; (8): 4 (In Russ.)].
  7. Beato M., Klug J. Steroid hormone receptors: An update. Hum Reprod Update. 2000, 6(3): 225–36. https://dx.doi.org/10.1093/humupd/6.3.225.
  8. Ramamoorthy S., Cidlowski J.A. Corticosteroids: Mechanisms of action in health and disease. Rheum Dis Clin North Am. 2016; 42(1): 15–31, vii. https://dx.doi.org/10.1016/j.rdc.2015.08.002.
  9. Stahn C., Buttgereit F. Genomic and nongenomic effects of glucocorticoids. Nat Clin Pract Rheumatol. 2008; 4(10): 525–33. https://dx.doi.org/10.1038/ncprheum0898.
  10. Strehl C., Buttgereit F. Unraveling the functions of the membrane-bound glucocorticoid receptors: First clues on origin and functional activity. Ann N Y Acad Sci. 2014; 1318: 1–6. https://dx.doi.org/10.1111/nyas.12364.
  11. Vandevyver S., Dejager L., Tuckermann J., Libert C. New insights into the anti-inflammatory mechanisms of glucocorticoids: An emerging role for glucocorticoid-receptor-mediated transactivation. Endocrinology. 2013; 154(3): 993–1007. https://dx.doi.org/10.1210/en.2012-2045.
  12. De Bosscher K., Haegeman G. Minireview: Latest perspectives on antiinflammatory actions of glucocorticoids. Mol Endocrinol. 2009; 23(3): 281–91. https://dx.doi.org/10.1210/me.2008-0283.
  13. Schacke H., Docke W.D., Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002; 96(1): 23–43. https://dx.doi.org/10.1016/s0163-7258(02)00297-8.
  14. Uhlenhaut N.H., Barish G.D., Yu R.T. et al. Insights into negative regulation by the glucocorticoid receptor from genome-wide profiling of inflammatory cistromes. Mol Cell. 2013; 49(1): 158–71. https://dx.doi.org/10.1016/j.molcel.2012.10.013.
  15. Song I.H., Buttgereit F. Non-genomic glucocorticoid effects to provide the basis for new drug developments. Mol Cell Endocrinol. 2006; 246(1–2): 142–46. https://dx.doi.org/10.1016/j.mce.2005.11.012.
  16. Panettieri R.A., Schaafsma D., Amrani Y. et al. Non-genomic effects of glucocorticoids: An updated view. Trends Pharmacol Sci. 2019; 40(1): 38–49. https://dx.doi.org/10.1016/j.tips.2018.11.002.
  17. Kong F., Liu Z., Jain V.G. et al. Inhibition of IRAK1 ubiquitination determines glucocorticoid sensitivity for TLR9-induced inflammation in macrophages. J Immunol. 2017; 199(10): 3654–67. https://dx.doi.org/10.4049/jimmunol.1700443.
  18. Vernocchi S., Battello N., Schmitz S. et al. Membrane glucocorticoid receptor activation induces proteomic changes aligning with classical glucocorticoid effects. Mol Cell Proteomics. 2013; 12(7): 1764–79. https://dx.doi.org/10.1074/mcp.M112.022947.
  19. Nicolaides N..C, Charmandari E. Novel insights into the molecular mechanisms underlying generalized glucocorticoid resistance and hypersensitivity syndromes. Hormones (Athens). 2017; 16(2): 124–38. https://dx.doi.org/10.14310/horm.2002.1728.
  20. Sevilla L.M., Jimenez-Panizo A., Alegre-Marti A. et al. Glucocorticoid resistance: Interference between the glucocorticoid receptor and the MAPK signalling pathways. Int J Mol Sci. 2021; 22(18): 10049. https://dx.doi.org/10.3390/ijms221810049.
  21. Fischer A., Gluth M., Weege F. et al. Glucocorticoids regulate barrier function and claudin expression in intestinal epithelial cells via MKP-1. Am J Physiol Gastrointest. Liver Physiol. 2014; 306(3): G218–28. https://dx.doi.org/10.1152/ajpgi.00095.2013.
  22. Ishiguro Y., Ohkawara T., Sakuraba H. et al. Macrophage migration inhibitory factor has a proinflammatory activity via the p38 pathway in glucocorticoid-resistant ulcerative colitis. Clin Immunol. 2006; 120(3): 335–41. https://dx.doi.org/10.1016/j.clim.2006.05.010.
  23. Slominski R.M., Tuckey R.C., Manna P.R. et al. Extra-adrenal glucocorticoid biosynthesis: Implications for autoimmune and inflammatory disorders. Genes Immun. 2020; 21(3): 150–68. https://dx.doi.org/10.1038/s41435-020-0096-6.
  24. Quatrini L., Ugolini S. New Insights into the cell- and tissue-specificity of glucocorticoid actions. Cell Mol Immunol. 2021; 18(2): 269–78. https://dx.doi.org/10.1038/s41423-020-00526-2.
  25. Dendoncker K., Timmermans S., Vandewalle J. et al. TNF-α inhibits glucocorticoid receptor-induced gene expression by reshaping the GR nuclear cofactor profile. Proc Natl Acad Sci USA. 2019; 116(26): 12942 –51. https://dx.doi.org/10.1073/pnas.1821565116.
  26. Xavier A.M., Anunciato A.K., Rosenstock T.R., Glezer I. Gene expression control by glucocorticoid receptors during innate immune responses. Front Endocrinol (Lausanne). 2016; 7: 31. https://dx.doi.org/10.3389/fendo.2016.00031.
  27. Борисова Е.О. Нежелательные эффекты системной глюкокортикостероидной терапии. Клиническая геронтология. 2009; 15(8–9): 19–26. [Borisova E.O. Side effects of systemic glucocorticosteroid therapy. Klinicheskaya gerontologiya = Clinical Gerontology. 2009; 15(8–9): 19–26 (In Russ.)]. EDN: KWXMVV.
  28. Truelove S.C., Witts L.J. Cortisone in ulcerative colitis; Final report on a therapeutic trial. Br Med J. 1955; 2(4947): 1041–48. https://dx.doi.org/10.1136/bmj.2.4947.1041.
  29. Baron J.H., Connell A.M., Kanaghinis T.G. et al. Out-patient treatment of ulcerative colitis. Comparison between three doses of oral prednisone. Br Med J. 1962; 2(5302): 441–43. https://dx.doi.org/10.1136/bmj.2.5302.441.
  30. Leohard-Jones J.E., Longmore A.J., Newell A.C. et al. An assessment of Lennard prednisone, salazopyrin, and topical hydrocortisone hemisuccinate used as out-patient treatment for ulcerative colitis. Gut. 1960; 1(3): 217–22. https://dx.doi.org/10.1136/gut.1.3.217.
  31. Harbord M., Eliakim R., Bettenworth D. et al.; European Crohn’s and Colitis Organisation [ECCO]. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017; 11(7): 769–84. https://dx.doi.org/10.1093/ecco-jcc/jjx009.
  32. Truelove S.C., Jewell D.P. Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet. 1974; 1(7866): 1067–70. https://dx.doi.org/10.1016/s0140-6736(74)90552-2.
  33. Turner D., Walsh C.M., Steinhart A.H., Griffiths A.M. Response to corticosteroids in severe ulcerative colitis: A systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007; 5(1): 103–10. https://dx.doi.org/10.1016/j.cgh.2006.09.033.
  34. Rosenberg W., Ireland A., Jewell D.P. High-dose methylprednisolone in the treatment of active ulcerative colitis. J Clin Gastroenterol. 1990; 12(1): 40–41. https://dx.doi.org/10.1097/00004836-199002000-00011.
  35. Lichtenstein G.R., Feagan B.G., Cohen R.D. et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol. 2012; 107(9): 1409–22. https://dx.doi.org/10.1038/ajg.2012.218.
  36. Raine T., Bonovas S., Burisch J. et al. ECCO guidelines on therapeutics in ulcerative colitis: Medical treatment. J Crohns Colitis. 2022; 16(1): 2–17. https://dx.doi.org/10.1093/ecco-jcc/jjab178.
  37. Lamb C.A., Kennedy N.A., Raine T. et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019; 68(Suppl 3): s1–s106. https://dx.doi.org/10.1136/gutjnl-2019-318484.
  38. Ko C.W., Singh S., Feuerstein J.D. et al.; American Gastroenterological Association Institute Clinical Guidelines Committee. AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis. Gastroenterology. 2019; 156(3): 748–64. https://dx.doi.org/10.1053/j.gastro.2018.12.009.
  39. Summers R.W., Switz D.M., Sessions J.T. Jr. et al. National Cooperative Crohn’s Disease Study: Results of drug treatment. Gastroenterology. 1979; 77(4 Pt 2): 847–69.
  40. Malchow H., Ewe K., Brandes J.W. et al. European Cooperative Crohn’s Disease Study (ECCDS): Results of drug treatment. Gastroenterology. 1984; 86(2): 249–66.
  41. Benchimol E.I., Seow C.H., Steinhart A.H., Griffiths A.M. Traditional corticosteroids for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2008; 2008(2): CD006792. https://dx.doi.org/10.1002/14651858.CD006792.
  42. Gomollon F., Dignass A., Annese V. et al.; ECCO. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis. 2017; 11(1): 3–25. https://dx.doi.org/10.1093/ecco-jcc/jjw168.
  43. Lichtenstein G.R., Loftus E.V., Isaacs K.L. et al. ACG clinical guideline: Management of Crohn’s disease in adults. Am J Gastroenterol. 2018; 113(4): 481 – 517. https://dx.doi.org/10.1038/ajg.2018.27.
  44. Torres J., Bonovas S., Doherty G. et al. ECCO guidelines on therapeutics in Crohn’s disease: Medical treatment. J Crohns Colitis. 2020; 14(1): 4–22. https://dx.doi.org/10.1093/ecco-jcc/jjz180.
  45. Ивашкин В.Т., Шелыгин Ю.А., Абдулганиева Д.И. с соавт. Рекомендации Российской гастроэнтерологической ассоциации и ассоциации колопроктологов России по диагностике и лечению взрослых больных язвенным колитом. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015; 25(1): 48–65. [Ivashkin V.T., Shelygin Yu.A., Abdulganieva D.I. et al. Recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia on the diagnosis and treatment of adult patients with ulcerative colitis. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015; 25(1): 48–65 (In Russ)]. EDN: UIORXR.
  46. Ивашкин В.Т., Шелыгин Ю.А., Халиф И.Л. с соавт. Рекомендации Российской гастроэнтерологической ассоциации и ассоциации колопроктологов России по диагностике и лечению болезни Крона. Колопроктология. 2017; (2): 7–29. [Ivashkin V.T., Shelygin Yu.A., Khalif I.L. et al. Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia on diagnosis and treatment of Crohn’s disease. Koloproktologiya = Coloproctology. 2017; (2): 7–29 (In Russ.)]. EDN: YNUIMH.
  47. Головенко О.В., Головенко А.О. Современные принципы лечения воспалительных заболеваний кишечника глюкокортикостероидами. Пособие для врачей. М. 2015, 43 с. [Golovenko O.V., Golovenko A.O. Modern principles of treatment of inflammatory bowel diseases with glucocorticosteroids. Manual for doctors. Moscow. 2015; 43 pp. (In Russ.)].
  48. Головенко А.О. Предикторы эффективности глюкокортикостероидов и инфликсимаба при тяжелой атаке язвенного колита. Автореферат дисс. на соиск. уч. ст. кандидата медицинских наук: специальность 14.01.04. М. 2016; 22 с. Доступ: https://new.gnck.ru/specialists/dissertatsii-gntsk/dissertation/golovenko_diss.pdf (дата обращения – 01.09.2023). [Golovenko A.O. Predictors of the effectiveness of glucocorticosteroids and infliximab in severe attack of ulcerative colitis. Abstract of the dissertation for the degree of PhD in Medical Sciences: specialty 14.01.04. Moscow. 2016; 22 pp. URL: https://new.gnck.ru/specialists/dissertatsii-gntsk/dissertation/golovenko_diss.pdf (date of access – 01.09.2023) (in Russ.)].
  49. Клинические рекомендации. Язвенный колит. Российская гастроэнтерологическая ассоциация, Общероссийская общественная организация «Ассоциация колопроктологов России». Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 193. Доступ: https://cr.minzdrav.gov.ru/schema/193_1 (дата обращения – 01.09.2023). [Clinical guidelines. Ulcerative colitis. Russian Gastroenterological Association, Association of Coloproctologists of Russia. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2020. ID: 193. URL: https://cr.minzdrav.gov.ru/schema/193_1 (date of access – 01.09.2023) (In Russ.)].
  50. Шелыгин Ю.А., Ивашкин В.Т., Белоусова Е.А. с соавт. Язвенный колит (К51), взрослые. Колопроктология. 2023; 22(1): 10–44. [Shelygin Yu.A., Ivashkin V.T., Belousova E.A. et al. Ulcerative colitis (K51), adults. Koloproktologiya = Coloproctology. 2023; 22(1): 10–44 (In Russ.)]. https://dx.doi.org/10.33878/2073-7556-2023-22-1-10-44. EDN: GDYCMT.
  51. Клинические рекомендации. Болезнь Крона. Российская гастроэнтерологическая ассоциация, Общероссийская общественная организация «Ассоциация колопроктологов России». Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 176. Доступ: https://cr.minzdrav.gov.ru/schema/176_1 (дата обращения – 01.09.2023). [Clinical guidelines. Crohn’s disease. Russian Gastroenterological Association, Association of Coloproctologists of Russia. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2020. ID: 176. URL: https://cr.minzdrav.gov.ru/schema/176_1 (date of access – 01.09.2023) (In Russ.)].
  52. Ferretti F., Cannatelli R., Monico M.C. et al. An update on current pharmacotherapeutic options for the treatment of ulcerative colitis. J Clin Med. 2022; 11(9): 2302. https://dx.doi.org/10.3390/jcm11092302.
  53. Криштопенко С.В., Тихов М.С., Попова Е.Б. Доза – эффект. М.: Медицина. 2008; 288 с. [Krishtopenko S.V., Tikhov M.S., Popova E.B. The dose effect. Moscow: Meditsina. 2008; 288 pp. (In Russ.)]. ISBN: 5-225-03979-0.

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