Authors: Jeuring SFG et al. Summary: Changes in corticosteroid use over time and the corticosteroid-sparing effects of immunomodulators and biologicals were investigated in a real-life cohort of patients with newly diagnosed IBD from the Dutch general population. Corticosteroid exposure and cumulative days of use were compared between patients diagnosed with CD or UC during 1991–1998 (n=316 and 539, respectively), 1999–2005 (n=387 and 527) and 2006–2011 (n=459 and 595). The corticosteroid exposure rate remained stable at 54.0% in CD and 31.4% in UC over time. The cumulative corticosteroid use in CD decreased from 366 days in the 1991–1998 period to 120 days in the 2006–2011 period (p<0.01), and for UC there was an initial decrease from 184 to 166 days between 1991–1998 and 1999–2005 (p=0.03) after which it stabilised. Only in CD did immunomodulator and biological users have a lower risk of requiring corticosteroids compared with matched controls (33.6% vs. 49.9% [p<0.01] and 25.7% vs. 38.2% [p=0.04], respectively).
Comment: Corticosteroids have well-known and well-documented side effects, are not well tolerated by patients and lead to loss of corticosteroid response with prolonged use. However, this group of agents are known to induce remission in patients with IBD. With the advent of broad adoption of biological agents (within the limits of the PBS guidelines in Australia), it is useful to review the extent of corticosteroid-sparing in IBD. This Dutch study of both UC and CD patients found that the cumulative use of steroids fell substantially, with the finding more marked for CD patients, falling from a cumulative use of 366 days in the 1991–1998 period to 120 days in the 2006–2011 period.
Reference: Am J Gastroenterol 2018;113:384–95