P691 Corticosteroids usage in patients with inflammatory bowel disease: Results of a multi-national audit in Asia
D.H. Kim1, D.I. Park2, T. Kobayashi3, V. Ahuja4, B.I. Jang5, Q. Cao6, Y.J. Lee7, Z. Ran8, Clinical Research Committee of Asian Organization for Crohn’s and Colitis (AOCC)
1Cha Bundang Medical Center, Cha University School of Medicine, Digestive Disease Center, Seongnam, Korea Republic of, 2Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Republic of, 3Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan, 4Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India, 5Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea Republic of, 6Department of Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, Hangzhou, China, 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea Republic of, 8Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Background
The use of corticosteroids (CS) has been a well-established treatment for active Inflammatory bowel disease (IBD). While many investigators have reported the efficacy of CS in treating IBD, systemic CS are often associated with various side-effects. The aim of this study was to investigate the present status of CS usage in Asian patients with IBD.
Methods
Authors reviewed medical records of IBD patients who were regularly followed at multiple centres in South Korea, China, Japan, and India. Patient characteristics including diagnosis, phenotype, severity at diagnosis, and treatment history of CS usage in the prior 12 months were collected using web-based case report form. All cases of CS usage were reviewed of its suitability and were categorised as ‘non-IBD’, ‘appropriate’, and ‘avoidable’ groups.
Results
A total of 1,291 patients (434 Crohn’s disease [CD], 848 ulcerative colitis [UC], and 9 Indeterminate colitis) from 4 countries (18 physicians from 8 hospitals) were reviewed between May and September 2019. Among them, 339 patients (26.3%) received CS during the past year. There was no significant difference in the incidence of CS use between CD and UC patients. Multiple CS exposure over the recent 12 months were identified in 16 patients (4.7%). The mean duration of CS use was 96.5 days. Short-term and long-term side-effects of CS occurred in 21 (6.1%) and 4 (1.2%) patients, respectively. 285 patients (84.1%) were able to reduce the dosage of CS below the prednisolone equivalent of 10mg/day within 3 months from CS initiation without recurrence of the disease. However, 15 patients (4.4%) relapsed after stopping CS. A total of 340 CS used cases were confirmed in the 339 patients when cases with undeterminable suitability of its use were excluded and 36 events (10.6%) were classified as avoidable CS use. Patients who received ‘avoidable’ CS had longer disease duration than who received ‘appropriate’ CS (3227.5 days and 1450.5 days, respectively.
Conclusion
Treatment for IBD is advancing; however, a significant proportion of patients still receive CS. In particular, the longer the disease duration, ‘avoidable’ CS uses in patients tend to increase. Application of CS in patients with IBD should be delivered with much caution, as ‘avoidable’ CS use is associated with longer CS use.