Prevalence of Corticosteroids Use and Disease Course After Initial Steroid Exposure in Ulcerative Colitis
- 508 Downloads
Limited nationwide data currently exists regarding corticosteroid (CS) use and long-term outcome after CS initiation in ulcerative colitis (UC).
The purpose of this study was to assess CS use prevalence and long-term outcomes after the index CS exposure. Our outcomes of interest were CS use level (reintroduction, dependency, and refractoriness), thiopurine use, and colectomy.
Nationwide data was obtained from the Veterans Affairs (VA) healthcare system for the period 2001–2011. Patients with UC were included if they had been diagnosed in the VA system and if they had filled CS for the first time during the observation period. A retrospective cohort design and time-to-event survival analysis was used to track outcomes of interest.
A total of 1,038 newly-diagnosed patients with UC were identified. The prevalence of CS use over the observation period was 45 %. Four hundred sixty-four CS users with median follow-up of 3.4 years were included. Among the included patients, 65 % required CS reintroduction, 38 % were classified as CS dependent, and 11 % were classified as CS refractory mostly within 2 years after the index CS course. Respectively, 8.6 and 38 % had colectomy and received thiopurine. Colectomy and thiopurine use rates varied significantly according to CS use level.
Approximately half of newly-diagnosed patients with UC required CS. Among CS users, one third of the patients had a sustained response after the initial CS course while two-thirds required further CS therapy. We observed a trend towards higher than previously reported thiopurine use accompanied by marked reduction in colectomy rates.
KeywordsCorticosteroids Ulcerative colitis Thiopurine Colectomy Veterans Affairs
This study was funded in full by the Department of Veterans Affairs, Veterans Health Administration, Office of Research & Development Health Services, grant number (VA Project No. 425).
Conflict of interest
- 8.The National Center for Veterans Analysis and Statistics (NCVAS). Trends in the Utilization of VA Programs and Services. 2012; www.va.gov/vetdata. Accessed 21 April 2012.
- 9.Khan N, Abbas AM, Almukhtar RM, Khan A. Prevalence and predictors of low bone mineral density in males with ulcerative colitis. J Clin Endocrinol Metab. 2013;98:2368–2375. Google Scholar
- 13.Ha CY, Newberry RD, Stone CD, Ciorba MA. Patients with late-adult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol. 2010;8:682–687. Google Scholar
- 15.Klein RE, Stockford DD. Data on the Socioeconomic Status of Veterans and on VA Program Usage. Office of the Actuary, Veterans Health Administration. 2001; http://www.va.gov/vetdata/docs/SpecialReports/sesprogramnet5-31-01.pdf. Accessed 10 June 2013.
- 19.U.S. Government Accountability Office Report. Veterans Health Care: Use of VA Services by Medicare-Eligible Veterans. 1994; http://www.gao.gov/products/HEHS-95-13. Accessed 19 February 2013.