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| |  Steroids Widely Used to Treat Crohn's Disease, Despite Serious Side Effects NASHVILLE, TN -- October 12, 2000 -- Corticosteroids remain the leading therapy for Crohn's disease despite the possible risk of serious side effects, according to a new nationwide physician survey. Among physicians who use medications to treat Crohn's disease, 88 percent choose steroids to treat flare-ups in patients with severe cases, while 75 percent prescribe them for moderate cases. The survey, conducted by Yankelovich Partners and issued by Vanderbilt University, found that widespread reliance on steroids continues, even though more than half (55 percent) of physicians identified osteoporosis as a potential long-term side effect associated with their use. Furthermore, almost one- third (29 percent) cited cataracts and high blood pressure (27 percent) as other common steroid side effects. "While steroids can be effective in controlling symptoms for the short- term, physicians need to carefully monitor patients' response to treatment and evaluate their progress to minimize side effects -- which can occur even after a brief period of time and may be irreversible," said Charles A. Sninsky, M.D., associate director of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center. Physicians surveyed indicated they would utilize steroid therapy for long or indefinite periods. More than three-fourths (76 percent) of physicians would keep Crohn's patients on steroids from six months through an indefinite period to maintain remission. One-in-five (19 percent) would keep patients on steroids for one year. Overall, the average length of time physicians would use steroids to treat patients in remission is nine months. "The bottom line is that steroids are generally not effective for the extended maintenance of Crohn's disease, and therefore alternative therapies should be explored," said Dr. Sninsky. Some of the other side effects that were frequently cited as results of steroid use included weight gain (36 percent), fluid retention (21 percent), mood swings (9 percent) and moon face (8 percent). While steroids have a long history as the leading therapy for Crohn's disease, the treatment paradigm may be shifting. Although two-thirds of physicians (65 percent) continue to rely on steroids because of their fast onset of pain relief, the survey also showed that a move toward using other alternatives is growing. "The good news for all Crohn's patients is there are newer, safer and well-tolerated medications available today, like infliximab (also known as Remicade), that are emerging as proven treatment options that not only provide quick relief of symptoms without the side effects of steroids, but also help in healing the intestines. In recent studies, we also see that patients who receive Remicade are able to stop or greatly reduce their use of steroids," said Dr. Sninsky. In the survey, roughly one-third (29 percent) of physicians report using Remicade to treat severe flare-ups. Remicade has been available to Crohn's patients since August of 1998. "What's more," added Dr. Sninsky, "existing therapies such as immunomodulators may also be explored as effective alternatives for Crohn's patients in remission." Other therapies used to treat Crohn's disease flare-ups that were cited by physicians in the survey included 5-ASA drugs (59 percent moderate cases; 20 percent severe cases) and 6-mercaptopurine (8 percent moderate cases; 8 percent severe cases). Still, a third of physicians (30 percent) believe that some patients cannot ever be taken off steroids, which concerns Dr. Sninsky. "Our major concern is a flare-up of Crohn's symptoms when steroids are reduced. However, some of the symptoms that patients experience as they withdraw from steroids, like fatigue and joint pain, are in part due to the steroid use itself and a resulting adrenal insufficiency," he explained. "These symptoms can decrease as patients are tapered off steroids. More importantly, these and other symptoms can also be avoided by alternative therapies." Affecting about 400,000 people in the United States, Crohn's disease is a debilitating disorder characterized by inflammation of the gastrointestinal tract. The inflammation involves the mucosal lining of the gut and can spread across the entire wall of the large and small intestine. Symptoms include diarrhea, fever, abdominal pain and weight loss. In up to 30 percent of patients, Crohn's disease causes fistulas-openings that burrow through the bowel wall into nearby organs or through the surface of the skin. The disease, which has a serious impact on an individual's quality of life, can recur at various times over a lifetime, and there is no way to predict when a remission may occur or when symptoms may return.
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