Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.
Section of Gastroenterology, Division of Internal Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2021 Jun 1;116(6):1284-1293. doi: 10.14309/ajg.0000000000001220.
Corticosteroids are effective for inducing clinical remission in inflammatory bowel disease (IBD), but not for maintaining remission. Reducing corticosteroid use and dependence is an important treatment goal since their use is associated with adverse events. The extent to which the improvements in IBD therapy have led to less corticosteroid use in the modern era remains unclear.
We used the University of Manitoba Inflammatory Bowel Disease Epidemiologic Database to assess the cumulative annual dosing of corticosteroids on a per-patient basis for all persons with IBD in the province of Manitoba between 1997 and 2017. Joinpoint analysis was used to assess for trends in corticosteroid use and to look at variation in the trends over time.
The mean annual exposure to corticosteroids decreased from 419 mg/yr (1997) to 169 mg/yr (2017) for Crohn's disease (CD) (annual decline: 3.8% per year, 95% confidence interval 3.1-4.6) and from 380 to 240 mg/yr in ulcerative colitis (UC) (annual decline: 2.5% per year, 95% confidence interval 2.1-2.8). In CD, there was an acceleration in the rate of decline after 2007 (pre-2007, 1.9% decline per year; after 2007, 5.7% per year); there was no corresponding acceleration in the rate of decline in UC.
Corticosteroid use has decreased in both CD and UC over the past 2 decades, becoming more pronounced after 2007 in CD. Potential explanations include introduction and increasing penetrance of biologic therapy in CD and greater awareness of corticosteroid-related adverse events in IBD. Further work is required understand the drivers of persistent corticosteroid use in IBD and how this can be further reduced.
皮质类固醇可有效诱导炎症性肠病（IBD）的临床缓解，但不能维持缓解。减少皮质类固醇的使用和依赖是一个重要的治疗目标，因为它们的使用与不良事件有关。在现代，IBD 治疗的进步在多大程度上导致皮质类固醇的使用减少尚不清楚。
我们使用马尼托巴大学炎症性肠病流行病学数据库，评估了 1997 年至 2017 年间该省所有 IBD 患者的皮质类固醇累积年剂量。使用 Joinpoint 分析评估皮质类固醇的使用趋势，并观察随时间变化的趋势变化。
克罗恩病（CD）的皮质类固醇年平均暴露量从 1997 年的 419 毫克/年降至 2017 年的 169 毫克/年（每年下降 3.8%，95%置信区间为 3.1-4.6），溃疡性结肠炎（UC）从 380 毫克/年降至 240 毫克/年（每年下降 2.5%，95%置信区间为 2.1-2.8）。在 CD 中，2007 年后下降速度加快（2007 年前每年下降 1.9%；2007 年后每年下降 5.7%）；UC 中没有相应的下降速度加快。
在过去的 20 年中，CD 和 UC 中的皮质类固醇使用都有所减少，在 CD 中，2007 年后更为明显。潜在的解释包括生物治疗在 CD 中的引入和渗透增加，以及对 IBD 中皮质类固醇相关不良事件的认识提高。需要进一步研究以了解导致 IBD 中持续使用皮质类固醇的驱动因素，以及如何进一步减少皮质类固醇的使用。
