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. 2016 Jun 23;11(6):e0158017.
doi: 10.1371/journal.pone.0158017. eCollection 2016.

Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

Akbar K Waljee  1   2 , Wyndy L Wiitala  1 , Shail Govani  2 , Ryan Stidham  2 , Sameer Saini  1   2 , Jason Hou  3   4 , Linda A Feagins  5   6 , Nabeel Khan  7   8 , Chester B Good  9   10 , Sandeep Vijan  1   2 , Peter D R Higgins  2
Affiliations

Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

Akbar K Waljee et al. PLoS One. .

Erratum in

Abstract

Background and aims: Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans.

Methods: Retrospective review of Veterans Health Administration (VHA) data from 2002-2010.

Results: Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%.

Conclusions: Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Escalation to corticosteroid-sparing therapy for Veterans who were continuous corticosteroid users (CS).
Fig 2
Fig 2. Escalation to corticosteroid-sparing therapy for Veterans who were intermittent corticosteroid users (IS).
Fig 3
Fig 3. Mean predicted likelihood of escalation to corticosteroid-sparing therapy by deciles of Total Steroid Days among Veterans with a GI visit (square) vs. no GI visit (diamond) during the study period.
Vertical lines (slightly offset for better visibility) represent 95% Confidence Intervals. Predicted escalation adjusted for age, male gender, the use of CS vs. IS, and clustering by facility.
Fig 4
Fig 4. Risk of Venothromboembolism among Veterans with IBD.
Fig 5
Fig 5. Risk of Fragility fractures among Veterans with IBD.
Fig 6
Fig 6. Risk of Infections among Veterans with IBD.
See this image and copyright information in PMC

References

    1. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Annals of internal medicine. 1990;112(5):352–64. . - PubMed
    1. Higgins PD, Skup M, Mulani PM, Lin J, Chao J. Increased Risk of Venous Thromboembolic Events With Corticosteroid vs Biologic Therapy for Inflammatory Bowel Disease. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2014. 10.1016/j.cgh.2014.07.017 . - DOI - PubMed
    1. Wang AS, Armstrong EJ, Armstrong AW. Corticosteroids and wound healing: clinical considerations in the perioperative period. American journal of surgery. 2013;206(3):410–7. 10.1016/j.amjsurg.2012.11.018 . - DOI - PubMed
    1. Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Annals of internal medicine. 1995;123(2):132–42. . - PubMed
    1. Ardizzone S, Maconi G, Russo A, Imbesi V, Colombo E, Bianchi Porro G. Randomised controlled trial of azathioprine and 5-aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut. 2006;55(1):47–53. 10.1136/gut.2005.068809 - DOI - PMC - PubMed

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