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Heavy, early corticosteroid use in IBD patients increased risk for resection
Patients with inflammatory bowel disease who used heavy doses of prednisone or other corticosteroids during their first year with the disease were nearly three times more likely to require resective surgery than others in a recent study.
Researchers analyzed data from the University of Manitoba Inflammatory Bowel Disease Epidemiology Database on 5,300 patients (mean follow-up, 6.6 years; 54.5% women) with inflammatory bowel disease (IBD). Patients were diagnosed between 1995 and 2010 with either ulcerative colitis (UC; n=2,782) or Crohn’s disease (CD; n=2,518).
“Heavy” users of corticosteroids were defined as patients who had received cumulatively at least 3,000 mg prednisone or equivalent within a single 365-day period; 12.3% of all patients fell into this group. Researchers said those diagnosed with IBD after 2002 were more likely to become heavy users (HR=1.16; 95% CI, 1.02-1.31). Researchers also found that a growing proportion of patients were prescribed corticosteroids in the first year after IBD diagnosis; citing that in 2008, 41% of patients were prescribed corticosteroids in that period compared with 34% of patients in 1995 (P=.0025 for trend).
Overall, 35.2%, 52%, and 62.8% of IBD patients had received corticosteroids within 1, 5, and 10 years of diagnosis, respectively. The researchers said these patients were “significantly more likely” to have surgery compared with those who used no corticosteroids within the first year. The adjusted hazard ratio for requiring resective surgery was 2.86 (95% CI, 2.2-3.73) among UC and CD patients who had heavy use of corticosteroids within that time period.
“We have demonstrated that there exists a significant burden of corticosteroid use among a population of persons with IBD, with over two-thirds of the population being exposed within 10 years of diagnosis, with 3% to 5% of long-term IBD patients using corticosteroids at any time,” the investigators wrote. “Cumulative exposure to corticosteroid use is not decreasing despite increasing uptake of immunomodulators.”
Disclosure: The researchers report no relevant financial disclosures.