Masuda Masataka, Fukata Norimasa, Sano Yasuki, Nishimon Shuhei, Aoi Mamiko, Tomiyama Takashi, Fukui Toshiro, Omiya Mika, Okazaki Kazuichi, Naganuma Makoto
Third Department of Internal Medicine, Division of Gastroenterology and Hepatology Kansai Medical University Hirakata Osaka Japan.
JGH Open. 2022 Aug 20;6(9):612-620. doi: 10.1002/jgh3.12796. eCollection 2022 Sep.
Trends in steroid use and the effects of the initial dose, duration of use, and tapering schedule on clinical efficacy were assessed in Japanese patients with ulcerative colitis (UC) undergoing steroid treatment.
We enrolled 191 cases with UC who underwent steroid treatment between 2006 and 2020. We assessed the difference in clinical remission rates in cases with different initial doses of steroid. Clinical factors for clinical remission at week 4 and discontinuation of corticosteroid within 12 weeks were also assessed.
Clinical remission and response at week 4 were obtained in 107 (56.0%) and 58 cases (30.4%), respectively. In hospitalized patients, male sex (odds ratio [OR], 0.373; 95% confidence interval [CI], 0.146-0.956) and younger age (OR, 0.974; 95% CI, 0.951-0.998) were associated with clinical remission at week 4. Partial Mayo score (OR, 0.643; 95% CI, 0.451-0.918) and initial steroid dose of ≥30 mg (OR, 3.278; 95% CI, 1.274-8.435) were associated with clinical remission at week 4 in outpatients. Clinical remission at week 4 (OR, 0.300; (95% CI, 0.126-0.718)) and the steroid dose reduction rate at week 4 (OR, 0.092; 95% CI, 0.036-0.234) were associated with treatment discontinuation within 12 weeks. The proportion of patients in whom corticosteroids were discontinued at week 12 was significantly higher ( = 0.006) in 2016-2020 (28/52; 53.8%) than in 2006-2010 (15/54; 27.8%).
The steroid reduction rate at week 4 may be critical for discontinuation within 12 weeks. Withdrawal of corticosteroids has been becoming more appropriate in the last 5 years than before.
评估日本溃疡性结肠炎（UC）患者接受类固醇治疗时类固醇使用趋势以及初始剂量、使用持续时间和减量方案对临床疗效的影响。
我们纳入了191例在2006年至2020年间接受类固醇治疗的UC患者。我们评估了不同初始类固醇剂量患者的临床缓解率差异。还评估了第4周临床缓解和12周内停用皮质类固醇的临床因素。
第4周时分别有107例（56.0%）和58例（30.4%）获得临床缓解和缓解反应。在住院患者中，男性（优势比[OR]，0.373；95%置信区间[CI]，0.146 - 0.956）和较年轻年龄（OR，0.974；95% CI，0.951 - 0.998）与第4周临床缓解相关。门诊患者中，部分梅奥评分（OR，0.643；95% CI，0.451 - 0.918）和初始类固醇剂量≥30 mg（OR，3.278；95% CI，1.274 - 8.435）与第4周临床缓解相关。第4周临床缓解（OR，0.300；（95% CI，0.126 - 0.718））和第4周类固醇剂量降低率（OR，0.092；95% CI，0.036 - 0.234）与12周内治疗中断相关。2016 - 2020年（28/52；53.8%）第12周停用皮质类固醇的患者比例显著高于2006 - 2010年（15/54；27.8%）（P = 0.006）。
第4周的类固醇减量率可能对12周内停药至关重要。在过去5年中，停用皮质类固醇比以前更为合适。
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