Analysis of the initial dose and reduction rate of corticosteroid for ulcerative colitis in clinical practice

Abstract

Background and aim: Trends in steroid use and the effects of the initial dose, duration of use, and tapering schedule on clinical efficacy were assessed in Japanese patients with ulcerative colitis (UC) undergoing steroid treatment.

Methods: We enrolled 191 cases with UC who underwent steroid treatment between 2006 and 2020. We assessed the difference in clinical remission rates in cases with different initial doses of steroid. Clinical factors for clinical remission at week 4 and discontinuation of corticosteroid within 12 weeks were also assessed.

Results: Clinical remission and response at week 4 were obtained in 107 (56.0%) and 58 cases (30.4%), respectively. In hospitalized patients, male sex (odds ratio [OR], 0.373; 95% confidence interval [CI], 0.146-0.956) and younger age (OR, 0.974; 95% CI, 0.951-0.998) were associated with clinical remission at week 4. Partial Mayo score (OR, 0.643; 95% CI, 0.451-0.918) and initial steroid dose of ≥30 mg (OR, 3.278; 95% CI, 1.274-8.435) were associated with clinical remission at week 4 in outpatients. Clinical remission at week 4 (OR, 0.300; (95% CI, 0.126-0.718)) and the steroid dose reduction rate at week 4 (OR, 0.092; 95% CI, 0.036-0.234) were associated with treatment discontinuation within 12 weeks. The proportion of patients in whom corticosteroids were discontinued at week 12 was significantly higher (P = 0.006) in 2016-2020 (28/52; 53.8%) than in 2006-2010 (15/54; 27.8%).

Conclusion: The steroid reduction rate at week 4 may be critical for discontinuation within 12 weeks. Withdrawal of corticosteroids has been becoming more appropriate in the last 5 years than before.

Keywords: corticosteroid; initial dose of corticosteroid; reduction rate of corticosteroid; ulcerative colitis.

Figure 1

The rate of clinical remission at week 4 by number of steroid courses

Figure 2

Differences of clinical efficacy at week 4 in hospitalized patients (a), and in outpatients (b) who received various initial dose of corticosteroids. *P value < 0.05. (), CR (+); (), CR (−)

Figure 3

Clinical efficacy of steroid treatment (a), initial dose of steroid (b), rate of decrease in steroid daily dose at week 4 (c) and at week 12 (d) every 5 years between 2006 and 2020. (a): (), CR (+); (), CR (−). (b): (), ≤20 mg; (), 21–40 mg; (), 41 mg. (c): (), 0–49%; (), 50–100%. (d): (), 0–99%; (), discontinuation.