Edward Loftus Jr., M.D., discusses a recent article published in Inflammatory Bowel Diseases about early corticosteroid use in inflammatory bowel disease (IBD) patients. The results show that heavy, early use of corticosteroids is a strong predictor of disease severity.
The study took place in Manitoba, Canada and used the provincial administrative health claims data. The patients in the study were diagnosed between 1984 and 2010. In order to be considered an IBD patient, the patient needed to make at least five medical claims. If a patient was in the data base for less than two years, he or she only needed two claims. There were over 5,000 patients in the data base and it was roughly 50/50 ulcerative colitis to Crohn's disease. The researchers were interested in looking at, at any given time, how many steroids was a patient on. The researchers were also interested in heavy steroid use which was defined as over 3,000mg cumulative over a 12 month period and the patients outcome with respect to surgery.
The researchers found the peak point prevalence for corticosteroids was about 60 days after diagnosis of IBD. At that point in time, 17% of the patients were on corticosteroids. After that time period, the point prevalence rapidly declined. If you did have a high dose corticosteroids within the first year, the rate of needing surgery was significantly higher.
The results tell physicians they can use steroids as a prognostic risk factor. The early use of corticosteroids general means the patient is going to have a higher risk of an adverse outcome, such as surgery. Does that mean steroids are making the condition worse? Probably not; it is probably a marker more severity. This study highlights the fact that early need for steroids is in fact a risk factor.
Read the full study online here.
To learn more about IBD, visit mayoclinic.org/ibd.
Dr. Loftus is a gastroenterologist at Mayo Clinic.