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P545. Bolus administration of steroid therapy is more favourable than the conventional use in preventing decrease of bone density and the increase of body fat percentage in patients with inflammatory bowel disease

K. Farkas1, A. Bálint1, Z. Valkusz1, Z. Szepes1, F. Nagy1, M. Szücs2, R. Bor1, T. Wittmann1, T. Molnár1, 1University of Szeged, First Department of Medicine, Szeged, Hungary, 2University of Szeged, Department of Medical Physics and Informatics, Szeged, Hungary

Background

The effects of short course of corticosteroids on the metabolic processes and bone formation has not been well studied. No randomized trials have studied and no guidelines have been developed on taper schedules. Our aim was to compare the efficacy, the frequency of side effects and the changes bone and lipid metabolism in IBD patients using bolus or conventional tapering of methylprednisolone for 12 weeks.

Methods

Nineteen IBD patients received intravenous methylprednisolone of 1 mg/kg for 5 days tapered by 4 mg per week. Patients were prospectively randomized in two groups. In “conventional” group (I) steroids were given daily. In “pulse” group (II) weekly dose of steroids were given on special days of the week. The body mass index (BMI) was measured before and after the corticosteroid therapy. Blood samples were collected to assess glucose level, electrolytes, cholesterol and triglycerides levels, inflammatory parameters, cortisol, osteocalcin and crosslaps values. Total body composition analysis was performed at the beginning and at the end of the steroid therapy to determine the fat and fat-free component of the body.

Results

In Group I, BMI increased, total body bone density decreased significantly at the end of the steroid therapy. Body fat percent showed a tendency to be higher at the end of steroid therapy in Group I. Serum cholesterol level increased significantly in Group I patients. The decrease in serum cortisol level was more remarkable in Group I vs. Group II after steroid therapy. Less side-effect occurred in Group II vs. Group I.

Conclusion

Our results suggest that bolus tapering of equivalent doses of methylprednisolone administered in conventional daily doses has equivalent clinical efficacy, but more favourable side effect profile. As no significant difference was detected between the two administration types on the clinical and laboratory parameters of disease activity, it appears that bolus administration of corticosteroids can safely and effectively replace the conventional use of methylprednisolone for active IBD.