People with inflammatory bowel disease (IBD) in the U.K. are commonly treated with corticosteroids, but a portion of these patients are treated excessively with steroids — and more than half of these could be avoided, a large-scale study suggests.
The study, “Assessment of steroid use as a key performance indicator in inflammatory bowel disease—analysis of data from 2385 UK patients,” was published in the journal Alimentary Pharmacology and Therapeutics.
In recent years, significant advances have been made to better understand the underlying mechanisms involved in IBD. This improved knowledge has supported the development and approval of new therapies, such as biological medicines that specifically prevent and help manage the autoimmune processes involved in this disease.
Still, corticosteroids — which can also regulate immune responses but in a more generalized manner — remain the most common treatment strategy for IBD. International studies have found that approximately 30–50% of IBD patients continue to be exposed to corticosteroids each year. In particular, about 10–20% of these patients take corticosteroids in excess, about half of which potentially could be avoided.
U.K. researchers conducted a large-scale study involving 11 clinical centers across England, Wales, and Scotland to further explore the trends of steroid use and its impact among IBD patients.
The study included a total of 2,385 patients, of whom 46.6% had Crohn’s disease, 49.9% had ulcerative colitis, and 3.5% had unspecified IBD.
Among the treatments used by this population were biologic therapies (in 26.8% of cases) — including anti‐TNF and anti-integrin antibodies — and 28% of patients took steroids within the previous 12 months.
A total of 352 patients (14.8%) were found to have been exposed to steroid excess. This was due to more than one course of steroid treatment within the prior year, a long-term (more than three months) treatment course, or a disease flare upon tapering steroid doses or shortly after stopping steroids.
The most commonly used steroids were prednisolone and budesonide taken orally, either alone (75.9% and 13.8% of cases, respectively) or in combination (10.3%).
Researchers determined that steroid excess was avoidable in 50.7% of cases, resulting in an incidence rate of 6.2% cases annually of excessive steroid use that could be avoided. No differences in the incidence of steroid excess were seen between people with ulcerative colitis and Crohn’s disease.
People who were followed at intervention centers — which were included in a quality improvement program — were found to be less likely to be exposed to excessive steroid therapy. At these centers, steroid use fell between 2015 and 2017, after the reimbursement of biologic therapies was approved on the U.K.’s National Health Service.
Researchers found that patients with Crohn’s disease had a lower risk of taking excessive steroids if they were also taking anti‐TNF agents, or if they were followed by a multidisciplinary team and at an intervention center. In contrast, Crohn’s patients who were treated with mesalazine showed a 1.72 times higher rate of steroid excess.
In ulcerative colitis, treatment with thiopurines alone was linked to a 1.97 times higher rate of excessive steroid use, while treatment at an intervention center was once more found to prevent the excessive use of steroids.
“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,” Christian P. Selinger, MD, of St. James University Hospital and lead author of the study, said in a press release.
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