Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;56(3):501-509.
doi: 10.1111/apt.17039. Epub 2022 May 24.

Sources of excess steroid prescriptions and clinical adverse outcomes associated with steroid excess in patients with inflammatory bowel disease: The Leeds IBD Steroids study

Konstantina Rosiou  1 , Jenelyn Carbonell  1 , Vivien Dolby  1 , Niloufar Monfared  1 , Tim Raine  2 , Christian P Selinger  1
Affiliations

Sources of excess steroid prescriptions and clinical adverse outcomes associated with steroid excess in patients with inflammatory bowel disease: The Leeds IBD Steroids study

Konstantina Rosiou et al. Aliment Pharmacol Ther. 2022 Aug.

Abstract

Background: Corticosteroids remain important for managing inflammatory bowel disease (IBD) flares. Steroid excess, however, may be a marker of poor care. Patients access steroid prescriptions from primary (General Practitioners [GP]) or secondary care (hospital-based). Sources of prescriptions and associated outcomes are not well described.

Methods: Patients attending IBD clinics with linked primary care information were included. We examined appropriateness and timeliness of treatment escalation and avoidability of steroid excess in relation to prescription sources.

Results: Of 2246 patients, 33% were exposed to steroids over 2 years. Primary care issued 28% of prescriptions. Secondary care prescriptions were more often of appropriate dose and duration (85% vs 41%, p < 0.001). Further flares occurred in 50% of patients prescribed steroids from primary care (vs 39%; p = 0.003). Steroid excess was observed in 15%. Patients with steroid excess who received prescriptions from primary care that were not communicated to secondary care less often received timely treatment escalation (49% vs 66%, p = 0.042) and steroid excess was more often avoidable (73% vs 56%, p = 0.022). Patients with steroid excess had higher risks of hospitalisation for IBD (OR = 12.33, 95% CI [8.89-17.11]), hospitalisation for infections (OR = 2.89, 95% CI [1.82-4.61]) and GP prescribed antibiotics (OR = 1.41, 95% CI [1.07-1.86]).

Conclusion: Patients commonly access steroids through primary care, but doses and durations are frequently inappropriate with patients more likely to flare. Steroid excess was associated with IBD admissions, admissions for infections and antibiotic prescriptions. Improved liaison between primary and secondary care is required to reduce steroid excess.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Ford AC, Bernstein CN, Khan KJ, Abreu MT, Marshall JK, Talley NJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590-9. quiz 600.
    1. Dorrington AM, Selinger CP, Parkes GC, Smith M, Pollok RC, Raine T. The historical role and contemporary use of corticosteroids in inflammatory bowel disease. J Crohns Colitis. 2020;14(9):1316-29.
    1. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1-s106.
    1. Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert JP, Raine T, et al. ECCO guidelines on therapeutics in Crohn's disease: medical treatment. J Crohns Colitis. 2020;14(1):4-22.
    1. Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, et al. ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. J Crohns Colitis. 2021;16:2-17.

Publication types

MeSH terms

LinkOut - more resources