Steroid use and misuse: a key performance indicator in the management of IBD

Blackwell, Jonathan; Selinger, Christian P.; Raine, Tim; Parkes, Gareth; Smith, Melissa A.; Pollok, Richard

doi:10.1136/flgastro-2019-101288

Cited by 22 publications

(16 citation statements)

References 86 publications

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“…Despite this fact, it has been documented that one in eight patients with UC and one in four patients with CD in the United Kingdom experience chronic steroid use of greater than 6 months. This was also found to be true in Europe, Canada, and the United States within the first 5 years of diagnosis 9 . Our study revealed that patients with chronic steroid use had an increased risk of thrombotic events, osteoporosis, and opportunistic infections.…”

Section: Discussionsupporting

confidence: 74%

“…This was also found to be true in Europe, Canada, and the United States within the first 5 years of diagnosis. 9 Our study revealed that patients with chronic steroid use had an increased risk of thrombotic events, osteoporosis, and opportunistic infections. The cause for the prothrombotic state in IBD appears to be due to local or systemic inflammation and is dependent on disease severity.…”

Section: Discussionmentioning

confidence: 69%

“…Current guidelines recommend 5‐aminosalicylic acid (5‐ASA) as a first‐line treatment option, before corticosteroids, in mild to moderate UC. Several therapies offer a possible steroid sparing option such as thiopurines, anti‐TNF agents, vedolizumab, ustekinumab, and tofacitinib 9 . Barriers to specialist advice, timely escalation, and patient education likely contribute to high rates of excess prescription steroids in a primary care setting.…”

Section: Discussionmentioning

confidence: 99%

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Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease

et al. 2022

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Background and Aim Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. Methods The fourth quarter of 2015–2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD‐10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates. Results A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality. Conclusion There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease

et al. 2022

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“…Truelove y Witts fueron los primeros en probar la cortisona, conocida como «las tabletas especiales», para inducir la remisión en la CU. Dos tercios de los pacientes en el grupo de tratamiento mejoraron o entraron en remisión clínica completa, en comparación con aproximadamente un tercio de los tratados con la terapia médica estándar de la época 33,34 . Por lo anterior comentado, el pionero de los ensayos clínicos controlados en la EII fue Sidney Charles Truelove, quien en 1955 publicó el primero de ellos realizado sobre la eficacia de los glucocorticoides en la CU grave.…”

Section: Glucocorticoidesunclassified

“…Se informó de que los glucocorticoides posteriores eran eficaces para la inducción de la remisión en la enfermedad de Crohn, y tres cuartas partes de los pacientes mejoraron inicialmente. Sin embargo, se hizo evidente que los beneficios a largo plazo de los glucocorticoides para los pacientes con EII eran menos favorables y estaban asociados con una amplia gama de efectos secundarios significativos 33 . En 1979, Summers y sus colaboradores informaron de que la prednisolona oral, a partir de 60 mg una vez al día, fue eficaz para inducir la remisión en pacientes con enfermedad de Crohn activa 14 .…”

Section: Glucocorticoidesunclassified

Breve historia de la terapia convencional en la colitis ulcerosa leve a moderada

Aguilar-Hernández¹,

Goudet-Vertiz²,

Cruz-Gapiz³

2022

IMIDS

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La colitis ulcerosa (CU) es una enfermedad inflamatoria intestinal recurrente y remitente caracterizada por una inflamación de la mucosa que comienza distalmente y puede extenderse en sentido proximal para afectar a todo el colon. Fue descrita por primera vez por el londinense Samuel Wilks y desde entonces se ha logrado entender cada día más hasta la actualidad. La primera terapia médica eficaz para la CU llegó con el descubrimiento de las sulfonamidas en 1938. La sulfasalazina se fabricó por primera vez en 1940 en Suecia por la compañía farmacéutica Pharmacia; se desarrolló inicialmente como un profármaco mediante la unión covalente de un resto de fármaco (sulfapiridina) a un agente químico no tóxico (ácido 5-aminosalicílico). Se han desarrollado varias formulaciones y recubrimientos de ácido 5-aminosalicílico para mejorar el suministro de mesalazina al sitio de la inflamación. Es un hecho que el ácido 5-aminosalicílico se considera una terapia de primera línea para inducir y mantener la remisión de la CU de leve a moderadamente activa.

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Factors associated with long‐term healthcare expense and steroid exposure in patients admitted with acute severe ulcerative colitis

Gilmore

Cheong

et al. 2023

JGH Open

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Background and Aim Acute severe ulcerative colitis (ASUC) remains a significant cause of morbidity and healthcare utilization. This study aimed to characterize the total healthcare costs of ASUC, explore factors associated with significant cost over the 12 months following an index admission, and document outcomes including corticosteroid exposure. Methods Patients admitted from January 2016 until January 2021 for ASUC to a tertiary inflammatory bowel disease (IBD) center in Australia were identified via retrospective chart review. Costs were calculated over a 12‐month period following index admission. Results Seventy‐two patients (30 [42%] female, median age 39 [IQR 27–54] years) were included. The median length of stay of index admission was 6 days (IQR 5–10 days). The median cost of index admission was 7829 AUD, which was driven by the initial length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median total healthcare cost over the first 12 months was 13 873 AUD (IQR 9684–19 936 AUD), again predominately driven by the length of stay (P < 0.01) and requirement for colectomy (P < 0.01). Median cumulative corticosteroid use over 12 months inclusive of index hospitalization was 1760 mg (IQR 1560–2350 mg). Requirement for inpatient medical salvage therapy with infliximab was associated with increased corticosteroid requirement (P = 0.01). Conclusion Healthcare expense related to ASUC remains high, driven predominantly by the length of stay during initial hospitalization and need for colectomy. From a healthcare cost perspective, novel methods to reduce inpatient hospital stay as well as need for colectomy may help reduce the economic and steroid burden of ASUC.

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Steroid use and misuse: a key performance indicator in the management of IBD

Cited by 22 publications

References 86 publications

Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease

Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease

Breve historia de la terapia convencional en la colitis ulcerosa leve a moderada

Factors associated with long‐term healthcare expense and steroid exposure in patients admitted with acute severe ulcerative colitis

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