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    To Taper or Not to Taper: That Is the Question

    For years doctors have tapered the dose of a steroid called prednisolone after prescribing it as a treatment for ulcerative colitis. But is it really necessary to gradually reduce the dose of steroids once the patient with a flare-up of ulcerative colitis has achieved remission?

    That's the question that researchers in Great Britain wanted to explore.

    "When you go back in history, there isn't much evidence for tapering prednisolone," said Dr. Atul Sinha, a gastroenterology researcher at University Hospital of Leicester and the lead investigator on a study that was presented at the Digestive Disease Week conference in San Diego. "For instance, in asthma, tapering isn't really necessary. You can give one sharp dose of steroids and then withdraw it."

    Economics was not a motivating factor for the study, Sinha added, because prednisolone is inexpensive. However, steroids can have significant side effects when taken long term, such as osteoporosis, masking infection and weight gain. Therefore, the less time a patient spends on this drug therapy, the better.

    The double-blind randomized study involved two groups of patients with active ulcerative colitis. Participants in both groups received 40 milligrams of oral prednisolone for two weeks. In the first group of patients, the dose was gradually decreased over a six-week period. The other group received a placebo during the six weeks tapering period.

    Of those patients who achieved remission while on the prednisolone and received the tapering doses, none experienced a relapse of their ulcerative colitis. However, of those that achieved remission and then received the placebos, about 60 percent experienced a relapse of their ulcerative colitis.

    The researchers concluded that gradual reduction of prednisolone after a two-week course of therapy for ulcerative colitis is necessary.

    "What most gastroenterologists have told us since the study is that we have demonstrated what we've known all along, but now there is evidence to support it," Sinha said. "However, there is not enough data about which tapering regime is the best. We chose in this study to taper the prednisolone over six weeks, which is standard, but maybe it would be better done over three weeks or 12 weeks. Now we're in the process of doing a study on tapering regimes."

    Most gastroenterologists are aware that gradually reducing the dose of steroids is the proper management of steroid therapy, but not all doctors may be aware of this, Sinha said.

    "What we see here in the UK is that people with flare-ups will go to their general practitioner who will sometimes treat them with steroids, then stop abruptly."

    Sinha's group of researchers also developed a simplified scale for diagnosing ulcerative colitis and presented it at the conference. The current tool for diagnosing is called the Powell-Tuck score and is used mainly by researchers.

    "The problem, though, is that the Powell-Tuck is difficult to use in a clinical setting," Sinha said.

    Sinha and his research team created an evaluation scale that involves only three questions and is much easier to use in a doctor's office. So far, they've found that the correlation between the new scale and the Powell-Tuck scoring system is accurate.



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