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. 2024 Oct 13:17:17562848241288851.
doi: 10.1177/17562848241288851. eCollection 2024.

Prescribed cumulative dosage of corticosteroids to patients with inflammatory bowel disease diagnosed between 2006 and 2020: a retrospective observational study

Johannes Iiristo  1 , Pontus Karling  2
Affiliations

Prescribed cumulative dosage of corticosteroids to patients with inflammatory bowel disease diagnosed between 2006 and 2020: a retrospective observational study

Johannes Iiristo et al. Therap Adv Gastroenterol. .

Abstract

Background: Treatments and strategies for inflammatory bowel disease (IBD) have gradually evolved in the 2000s.

Objectives: We investigated whether the prescription of corticosteroids (prednisolone and budesonide) in patients with IBD in the first 5 years after diagnosis changed in patients diagnosed between 2006 and 2018.

Design: Retrospective observational study.

Methods: The cumulative prescribed dosage of corticosteroids for the first 5 years after diagnosis was registered in all patients with IBD (n = 386) at our clinic for those diagnosed between 2006 and 2018.

Results: The proportion of patients with IBD who were prescribed at least one prescription of corticosteroids in year 1-5 after diagnosis was 55.3%, 27.9%, 22.7%, 14.1%, and 14.6%, respectively. The proportion of patients who had a cumulative dose of prednisolone >1 g in the first 5 years after diagnosis was 40.1% for ulcerative colitis and 34.9% for Crohn's disease (CD). The cumulative prescribed dosage (within 3 years after diagnosis) of prednisolone had declined (rs = -0.164, p = 001), but had increased for budesonide (rs = 0.202, p < 0.001) between 2006 and 2020. The prescription of any immunomodulator for IBD in the first 5 years from diagnosis was stable between 2006 and 2018 (rs = 0.056, p = 0.257), but there was a minor increase in the prescription of Tumor Necrosis Factor (TNF)-inhibitors (rs = 0.119, p = 0.020). The use of five-acetyl salicylic acid (5-ASA) decreased in patients with CD (rs = -201, p = 0.012).

Conclusion: There was a decrease in the prescription of prednisolone and an increase in the prescription of budesonide treatment from 2006 to 2023; however, the cumulative exposure to corticosteroids in patients with IBD remains at a relatively high level.

Keywords: 5-ASA; Crohn’s disease; biologics; budesonide; immunomodulators; inflammatory bowel disease; prednisolone; surgery; ulcerative colitis.

Plain language summary

The use of steroids in patients with inflammatory bowel disease diagnosed between 2006 and 2020 In the 1950s, corticosteroids and immunomodulators were introduced, and in combination with improved surgery, the mortality rates dramatically decreased in patients with inflammatory bowel disease (IBD) Although corticosteroids are effective in the short term they have no proven efficacy in long-term therapy for IBD, and owing to the risk of side effects, their long-term use should be restricted. Based on the evolution of treatments and treatment strategies for IBD in the 2000s, we aimed to study to the extent to which corticosteroids have been used in the first five years after diagnosis for patients with IBD diagnosed at our clinic between 2006 and 2020. To what extent is prednisolone prescribed in the first five years after diagnosis? Has the pattern of corticosteroid prescription changed after the introduction of advanced therapy and biosimilars to TNF inhibitors? We found that the proportion of patients with IBD who were prescribed at least one prescription of corticosteroids in year one to five after diagnosis was 55.3%, 27.9%, 22.7%, 14.1%, and 14.6%, respectively. The proportion of patients who had a cumulative dose of prednisolone >1g in the first five years after diagnosis was 40.1% for ulcerative colitis (UC) and 34.9% for Crohns disease (CD). The cumulative prescribed dosage (within 3 years after diagnosis) of prednisolone had declined but increased for budesonide between 2006-2020. The prescription of any immunomodulator for IBD in the first five years from diagnosis was stable between the years 2006-2018, but there was a minor increase in the prescription of TNF-inhibitors. The use of 5-ASA decreased in patients with CD. We conclude that there was a decrease in the prescription of prednisolone and an increase in the prescription of budesonide treatment from 2006 to 2023; however, the cumulative exposure to corticosteroids in patients with IBD remains on relatively high level.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart showing the process of patient inclusion in the study.
Figure 2.
Figure 2.
There was a significant decline in the cumulative prescribed prednisolone dosage in the first 3 years after diagnosis for patients with IBD diagnosed between 2006 and 2020 (rs = −0.164; p = 0.001). The black line indicates the median prescribed dosage and the bars the 75th percentile. Circles and asterisks show outliers. IBD, inflammatory bowel disease.
Figure 3.
Figure 3.
Patients with UC and CD diagnosed in 2006–2013 versus 2014–2020, and the proportion of patients that at least once received a prescription of prednisolone or budesonide in the first 5 years after diagnosis. CD, Crohn’s disease; UC, ulcerative colitis.
Figure 4.
Figure 4.
Kaplan-Meier curves showing the time to the first prescription of immunomodulators, biologics (TNF inhibitors), second-line treatment (vedolizumab, ustekinumab, or tofacitinib), and the time to first surgery after diagnosis in patients with UC. The blue line represents patients diagnosed in 2006–2013 and the green line represents patients diagnosed in 2014–2020. UC, ulcerative colitis.
Figure 5.
Figure 5.
Kaplan-Meier curves showing the time to the first prescription of immunomodulators, biologics (TNF inhibitors), second-line treatment (vedolizumab, ustekinumab, or tofacitinib), and the time to first surgery after diagnosis in patients with Crohn’s disease. The blue line represents patients diagnosed in 2006–2013 and the green line represents patients diagnosed in 2014–2020.
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