Corticosteroid use has decreased among patients with Crohn disease (CD) and ulcerative colitis (UC) during the past 2 decades, with the decline becoming more pronounced after 2007 in those with CD, researchers reported in the American Journal of Gastroenterology.
The investigators used the University of Manitoba Inflammatory Bowel Disease (IBD) Epidemiologic Database, which includes health care data for almost all residents with IBD in Manitoba, to assess trends in corticosteroid use over time.
From 1997 to 2017, the number of patients with IBD increased from 4778 (2494 CD, 2284 UC) to 8126 (3793 CD, 4433 UC). The study authors also observed an overall increase in patients’ mean age during this period, as well as an increasing frequency of anti–tumor necrosis factor (TNF) use.
Among patients with CD, the mean rate of corticosteroid use decreased from 419 mg of prednisone equivalents per year in 1997, to 169 mg of prednisone equivalents per year in 2017. This rate corresponded with a decrease of 3.8% per year in the overall amount of corticosteroids dispensed (95% CI, 3.1-4.6). The proportion of persons in each year who received any corticosteroid also decreased from 20.0% per year to 13.5% (relative rate of decline, 1.8% per year; 95% CI, –1.5 to 2.1)
Before 2007, the mean dose of corticosteroids for patients with CD was decreasing by 1.9% per year (95% CI, 0.8-3.1), but after 2007, the rate of the annual decrease increased to 5.7% per year (95% CI, 4.5-7.0).
For patients with UC, the mean annual dose of prednisone equivalents dispensed decreased from 380 mg per patient per year in 1997 to 240 mg per patient per year in 2017 (mean decrease per year of 2.5%; 95% CI, 2.1-2.8). A more modest decline was observed in the proportion of patients with UC who were dispensed a corticosteroid (17.1% in 1997 to 14.9% in 2017; annualized mean relative rate of decrease, 0.7%; 95% CI, 0.4-1.1). No inflection point corresponding with a variation in the rate of change in overall dosing of corticosteroids in patients with UC was observed.
In 2002, 1.4% of patients with CD were actively using anti-TNF therapies, compared with 13.1% in 2017. Among patients with UC in 2002, 0.2% were actively using anti-TNF therapies, compared with 6.4% in 2017.
Among several study limitations, the database did not include information about underlying disease severity or phenotype, and so the researchers could not precisely identify whether the decline in corticosteroid use over time was more or less pronounced among different patient profiles. Additionally, the findings may not be generalizable to non–anti-TNF biologics, as these agents were minimally used in this population before 2017.
“Reductions in corticosteroid use have further decreased among anti-TNF users, suggesting improving timing and dosing of biologic therapy over time,” stated the investigators. “Showing a benefit in the real world for biologic use in reducing corticosteroid use in IBD provides further impetus for relaxing restrictions on the use of these agents in clinical practice,” they concluded.
Disclosure: Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.
Targownik LE, Bernstein CN, Benchimol EI, et al. Trends in corticosteroid use during the era of biologic therapy: a population-based analysis. Am J Gastroenterol. 2021;116(6):1284-1293. doi:10.14309/ajg.0000000000001220