Curr Clin Pharmacol. 2020 Jul 14. doi: 10.2174/1574884715666200714114044.Online ahead of print.

Maria Carla Di Paolo ¹, Cristiano Pagnini ¹, Maria Giovanna Graziani ¹

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• ¹Department of Gastroenterology and Digestive Endoscopy , S. Giovanni Addolorata Hospital, Via dell' Amba Aradam 9, 00184 Rome. Italy.

Abstract

Inflammatory bowel diseases (IBDs) are chronic conditions characterized by unknown etiology and pathogenesis with deregulation of mucosal immunity. Among possible treatments, corticosteroids, already available from the 50', are still the mainstay of treatment for moderate-severe disease. Nonetheless, the use of steroids is still largely empirical and solid evidence about therapeutic schemes are lacking. Moreover, due to the important side-effects and for the unsatisfactory impact on long-term natural history of disease, the steroid sparing has become an important therapeutic goal in IBD management. Besides conventional steroids, the so called "low bioavailability" steroids, which are steroids with high affinity for peripheral receptors and elevated hepatic first-pass metabolism, have demonstrated efficacy and more favorable safety profile. In the present review of the literature evidence of efficacy and safety of conventional and low bioavailability steroids in IBD patients are evaluated, and practical suggestions for a correct use in clinical practice are presented according to the current clinical guidelines.