Corticosteroid Sparing in Inflammatory Bowel Disease is More Often Achieved in the Immunomodulator and Biological Era-Results from the Dutch Population-Based IBDSL Cohort

Steven F. G. Jeuring*, Vince B. C. Biemans, Tim R. A. van den Heuvel, Maurice P. Zeegers, Wim H. Hameeteman, Marielle J. L. Romberg-Camps, Liekele E. Oostenbrug, Ad A. M. Masclee, Daisy M. A. E. Jonkers, Marieke J. Pierik

*Corresponding author for this work

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Abstract

OBJECTIVES: Corticosteroid-free remission is an emerging treatment goal in the management of inflammatory bowel disease (IBD). In the population-based Inflammatory Bowel Disease South Limburg cohort, we studied temporal changes in corticosteroid use and assessed the corticosteroid-sparing effects of immunomodulators and biologicals in real life.

METHODS: In total, 2,823 newly diagnosed patients with Crohn's disease (CD) or ulcerative colitis (UC) were included. Corticosteroid exposure and cumulative days of use were compared between patients diagnosed in 1991-1998 (CD: n=316, UC: n=539), 1999-2005 (CD: n=387, UC: n=527), and 2006-2011 (CD: n=459, UC: n=595). Second, the corticosteroid-sparing effects of immunomodulators and biologicals were assessed.

RESULTS: Over time, the corticosteroid exposure rate was stable (54.0% in CD and 31.4% in UC), even as the cumulative corticosteroid use in the first disease year (CD: 83 days (interquartile range (IQR) 35189), UC: 62 days (IQR 0-137)). On the long-term, a gradual decrease in cumulative corticosteroid use was seen in CD (era '91-'98: 366 days (IQR 107-841), era '06-'11: 120 days (IQR 72-211), P

CONCLUSIONS: In a real-world setting, more recently diagnosed IBD patients used lower amounts of corticosteroids as of the second year of disease. For CD, a significant association was found with the use of immunomodulators and biologicals. These conclusions support the increasing use of these treatment modalities.

Original languageEnglish
Pages (from-to)384-395
Number of pages12
JournalAmerican Journal of Gastroenterology
Volume113
Issue number3
DOIs
Publication statusPublished - Mar 2018

Keywords

  • CROHNS-DISEASE
  • ULCERATIVE-COLITIS
  • NATURAL-HISTORY
  • INCEPTION COHORT
  • CONTROLLED-TRIAL
  • 5-AMINOSALICYLIC ACID
  • MEDICAL-MANAGEMENT
  • CLINICAL-COURSE
  • FOLLOW-UP
  • AZATHIOPRINE

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