Leeds, UK—Should steroid therapy for inflammatory bowel disease be limited to 3 months?

A study
in Alimentary Pharmacology and Therapeutics makes that argument. St. James University Hospital–led researchers note that steroid therapy is commonly used to treat acute attacks of ulcerative colitis and Crohn’s disease. They argue, however, that because the drugs do not provide long-term benefits and carry a risk of serious side effects, the course should be limited.

“Looking at steroid prescribing for inflammatory bowel disease and trying to reduce steroid excess can be a powerful way to improve patient care and outcomes,” explained lead author Christian P. Selinger, MD, MSc, of St. James University Hospital.

The study team assessed overuse of steroids in a large inflammatory bowel disease cohort to test associations with quality improvement and prescribing. Steroid exposure was recorded for outpatients at 19 medical centers. Researchers analyzed associated factors and assessed possible alternatives.

The study found that, of 2,385 patients, 28% received steroids in the preceding 12 months, with 14.8% demonstrating steroid excess or dependency.

Results indicate that steroid use was significantly lower at intervention centers that participated in a quality improvement program (exposure: 23.8% vs. 31.0%, P <.001; excess 11.5% vs. 17.1%, P <.001). In fact, at those facilities, steroid use fell from 2015 to 2017 (steroid exposure 30.0% to 23.8%, P = .003; steroid excess 13.8% to 11.5%, P = .17).

Researchers determined that steroid excess was avoidable in 50.7% of cases.

Factors independently associated with reduced steroid excess in Crohn’s disease included maintenance with antitumor necrosis factor (TNF) agents (OR 0.61; [95% CI, 0.24-0.95]), treatment in a center with a multidisciplinary team (OR 0.54 [95% CI, 0.20-0.86]), and treatment at an intervention center (OR 0.72 [95% CI, 0.46-0.97]). Treatment with 5-ASA in CD also was associated with higher rates of steroid excess (OR 1.72 [95% CI, 1.24-2.09]).

As for ulcerative colitis, thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI, 1.19-3.01]) as was treatment at an intervention center with less steroid excess (OR 0.72 [95% CI 0.45-0.95]).

“This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort,” the authors conclude, adding that a quality improvement program “was associated with lower steroid use.”

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