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

Abstract

Corticosteroids remain an important tool for inducing remission in inflammatory bowel disease (IBD) but they have no role in maintenance of remission. The significant adverse side effect profile of these drugs means their use should be avoided where possible or measures taken to reduce their risk. Despite an expanding array of alternative therapies, corticosteroid dependency and excess remain common. Appropriate steroid use is now regarded a key performance indicator in the management of IBD. This article aims to outline indications for corticosteroid use in IBD, their risks and strategies to reduce their use and misuse.

Keywords: 5-aminosalicylic acid (5-ASA); crohn's disease; inflammatory bowel disease; steroid-sparing efficacy; ulcerative colitis.

Figure 1

Proportion of prolonged steroid exposure (>3 months use and >6 months use) and repeated steroid exposure (restarting steroids within 3 months of previous course), adjusted for age and sex using logistic regression, within 5 years of diagnosis between era 1/2 and era 4/5 for Crohn’s disease (CD) (A) and ulcerative colitis (UC) (B). χ2 test for trend used to compare proportion between groups. Follow-up period 1990–2010. Reproduced with permission from Chhaya et al .