steroidrefractory

Steroidrefractory, sometimes written as steroid-refractory, is a clinical term used to describe conditions that do not respond adequately to corticosteroid therapy despite appropriate dosing and duration. It denotes a failure to achieve meaningful clinical or objective improvement after a standard course of steroids, leading clinicians to consider alternative or additional treatments. The concept is not limited to one disease but is applied across several specialties.

Common contexts include inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease, where steroidrefractory disease persists despite systemic corticosteroids and may require escalation to immunomodulators or biologic therapies, or surgical evaluation. It is also used in graft-versus-host disease, where acute or chronic GVHD continues despite steroid treatment, prompting second-line options. Other areas where the term is used include certain vasculitides and severe asthma, among others.

Approach to steroidrefractory disease typically involves confirming adherence and adequate drug exposure, excluding infection or other triggers, and reassessing the diagnosis and disease severity. Management usually shifts toward second-line immunosuppressants, biologic agents, or targeted therapies, such as calcineurin inhibitors, anti-TNF or anti-integrin antibodies, IL-12/23 inhibitors, and JAK inhibitors, along with supportive and organ-specific care. In some settings, non-pharmacologic options or experimental therapies may be explored. The designation often signals a more challenging disease course and the need for a tailored treatment strategy.