P514 Influence of the frequency of glucocorticosteroid therapy courses on the hormonal resistance in patients with ulcerative colitis.
Knyazev, O.(1,2,3);Tishaeva, I.(2);Kagramanova, A.(1);Shkurko, T.(3);Veselov, A.(3);
(1)Moscow Clinical Scientific Center named after A.S. Loginov, Department of IBD, Moscow, Russian Federation;(2)State Scientific Centre of Coloproctology named after A.N. Ryzhyh, Department of IBD, Moscow, Russian Federation;(3)Research Institute of Health Organization and Medical Management, Organization of Coloproctology, Moscow, Russian Federation
Background
One of the most effective anti-inflammatory agents in ulcerative colitis (UC) are glucocorticosteroids (GCS), which block the release of arachidonic acid, prevent the formation of inflammatory mediators, have an immunomodulatory effect, affect tissue fibrinolysis, which leads to a decrease in inflammation and bleeding of the mucous membrane. However, in 9-16% of patients UC, hormone resistance develops.
Objective: to establish the dependence of hormonal resistance on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS.
Methods
96 patients with moderate to severe UC (Truelove-Witts) who received several courses of GCS. Males 51 (53.1%), females 45 (46.9%). The median age was 34±4.2 years. The duration of the anamnesis was from 3 to 7 years (Me 4 years). Patients were divided into three groups depending on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS. Group 1-st (n=30) received ≤1 course of GCS for 12 months for UC exacerbation, group 2-nd (n=34)-1-2 courses of GCS, group 3-rd (n=32)-3 ≥ courses of GCS. The frequency of hormone resistance (HR) was compared in groups of patients.
Results
Among 96 patients with UC, HR was established in 12 (12.5%) patients. In group 1 of UC patients who received less than 1 course of GCS for 12 months for UC exacerbation, patients with HR were 1 (3.3%), in group 2-2 (5.9%) patients with HR, in group 3-9 (28.1%) patients with HR.
When comparing groups 1-st and 2-nd, it was found that the incidence of HR in both patients who received 1-2 courses of GCS for 12 months did not differ (OR-1.813; 95% CI 0.156 - 21.057; p>0.05).
When comparing the 1-st and 3-rd groups showed that the incidence of HR in patients who received 3 or more courses of corticosteroids within 12 months is significantly higher than in patients who received ≤1 course of corticosteroids within 12 months (OR-0.088; 95% CI, 0.010-0.747; p<0.05).
When comparing the 2-nd and 3-rd groups showed that the incidence of HR in patients who received more than 3 courses of corticosteroids within 12 months also has a tendency to a higher risk of development of HR than the patients receiving 2 or fewer courses of corticosteroids within 12 months (OR-0.160; 95% CI, 0.032-0.810; p<0.05).
Conclusion
The frequency of courses of glucocorticosteroid therapy for exacerbation of the disease for 12 months affects the risk of developing hormone resistance in patients with ulcerative colitis.