A multi‐centre audit of excess steroid use in 1176 patients with inflammatory bowel disease

Selinger, Christian P.; Parkes, Gareth; Bassi, A; Fogden, Edward; Hayee, Bu; Limdi, Jimmy K.; Ludlow, Helen; McLaughlin, Simon D.; Patel, Pritash; Smith, Melissa A.; Raine, Tim

doi:10.1111/apt.14334

Cited by 74 publications

(92 citation statements)

References 23 publications

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“…[3][4][5][6][7] Our study is the largest study to examine this relationship and found that smoking status at diagnosis did not impact on the likelihood of corticosteroid exposure. 41 In a multivariable analysis we found no difference in corticosteroid dependency between never-smokers, smokers and ex-smokers. These findings are consistent with a recent meta-analysis that found no difference in flares of disease activity according to smoking status.…”

Section: Findings In Relation To Previous Studiesmentioning

confidence: 68%

The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population‐based study

Blackwell

Saxena

Alexakis

et al. 2019

Aliment Pharmacol Ther

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Background:Smokers are less likely to develop ulcerative colitis (UC) but the impact of smoking and subsequent cessation on clinical outcomes in UC is unclear. Aim:To evaluate the effect of smoking status and smoking cessation on disease outcomes.Methods: Using a nationally representative clinical research database, we identified incident cases of UC during 2005-2016. Patients were grouped as never-smokers, ex-smokers and smokers based on smoking status recorded in the 2 years preceding UC diagnosis. We defined subgroups of persistent smokers and smokers who quit within 2 years after diagnosis. We compared the rates of overall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurine use, hospitalisation and colectomy between these groups. Results:We identified 6754 patients with a new diagnosis of UC over the study period with data on smoking status, of whom 878 were smokers at diagnosis. Smokers had a similar risk of corticosteroid-requiring flares (OR 1.16, 95% CI 0.92-1.25), thiopurine use (HR 0.84, 95% CI 0.62-1.14), corticosteroid dependency (HR 0.85, 95% CI 0.60-1.11), hospitalisation (HR 0.92, 95% CI 0.72-1.18) and colectomy (HR 0.78, 95% CI 0.50-1.21) in comparison with never-smokers. Rates of flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy were not significantly different between persistent smokers and those who quit smoking after a diagnosis of UC. Conclusions:Smokers and never-smokers with UC have similar outcomes with respect to flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy. Smoking cessation was not associated with worse disease course. The risks associated with smoking outweigh any benefits. UC patients should be counselled against smoking. | 557 BLACKWELL Et AL.

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Section: Findings In Relation To Previous Studiesmentioning

confidence: 68%

The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population‐based study

Blackwell

Saxena

Alexakis

et al. 2019

Aliment Pharmacol Ther

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“…Using a previously developed online assessment tool for steroid exposure in patients with IBD we prospectively collected data from IBD patients attending outpatient clinics over 3 months between April and July 2017. The participating sites worked with a standard operating procedure which required them to enrol all consecutive patients with IBD attending face to face clinics without patient selection beyond basic inclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

“…To allow for comparison with the 2015 study we used the same definitions as detailed previously . In short we recorded steroid exposure (number of courses, length of the longest course, ability to taper, flares on or within 3 months of withdrawal) for the 12‐month period preceding the clinic visit.…”

Section: Methodsmentioning

confidence: 99%

“…Although an effective induction agent, steroids have no role as a maintenance agent and prolonged exposure can lead to a range of significant morbidities . In both Europe and the USA, patient organisations have suggested that steroid free remission should be a key therapeutic target . Several international studies have shown that around 30%‐50% of patients continue to be exposed to corticosteroids each year, with around 10%‐20% exposed to significant excess corticosteroids, which was potentially avoidable in around half of these cases of excess .…”

Section: Introductionmentioning

confidence: 99%

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Assessment of steroid use as a key performance indicator in inflammatory bowel disease—analysis of data from 2385 UK patients

Selinger¹,

Parkes²,

Bassi

et al. 2019

Aliment Pharmacol Ther

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Summary Background Patients with IBD are at risk of excess corticosteroids. Aims To assess steroid excess in a large IBD cohort and test associations with quality improvement and prescribing. Methods Steroid exposure was recorded for outpatients attending 19 centres and associated factors analysed. Measures taken to avoid excess were assessed. Results Of 2385 patients, 28% received steroids in the preceding 12 months. 14.8% had steroid excess or dependency. Steroid use was significantly lower at ‘intervention centres’ which participated in a quality improvement programme (exposure: 23.8% vs 31.0%, P < .001; excess 11.5% vs 17.1%, P < .001). At intervention centres, steroid use fell from 2015 to 2017 (steroid exposure 30.0%‐23.8%, P = .003; steroid excess 13.8%‐11.5%, P = .17). Steroid excess was judged avoidable in 50.7%. Factors independently associated with reduced steroid excess in Crohn's disease included maintenance with anti‐TNF agents (OR 0.61 [95% CI 0.24‐0.95]), treatment in a centre with a multi‐disciplinary team (OR 0.54 [95% CI 0.20‐0.86]) and treatment at an intervention centre (OR 0.72 [95% CI 0.46‐0.97]). Treatment with 5‐ASA in CD was associated with higher rates of steroid excess (OR 1.72 [95% CI 1.24‐2.09]). In ulcerative colitis (UC), thiopurine monotherapy was associated with steroid excess (OR 1.97 [95% CI 1.19‐3.01]) and treatment at an intervention centre with less steroid excess (OR 0.72 [95% CI 0.45‐0.95]). Conclusions This study validates steroid assessment as a meaningful quality measure and provides a benchmark for this performance indicator in a large cohort. A programme of quality improvement was associated with lower steroid use.

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“…Introduction Corticosteroid (CS) overuse and dependency has been highlighted as a key clinical outcome in the management of inflammatory bowel disease (IBD) in a recent national audit 1 . Whilst data regarding clinician prescribed CS is available 2 , little is known about the magnitude of self-prescribed CS amongst IBD patients, and we therefore aimed to investigate self-prescribing habits.…”

mentioning

confidence: 99%

PWE-027 Self-medication with oral corticosteroids in amongst patients with inflammatory bowel disease

Jasim

Pollok

2018

Ibd

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A multi‐centre audit of excess steroid use in 1176 patients with inflammatory bowel disease

Cited by 74 publications

References 23 publications

The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population‐based study

The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population‐based study

Assessment of steroid use as a key performance indicator in inflammatory bowel disease—analysis of data from 2385 UK patients

PWE-027 Self-medication with oral corticosteroids in amongst patients with inflammatory bowel disease

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