Trends in Corticosteroid Use During the Era of Biologic Therapy: A Population-Based Analysis
| Autor: | Aruni Tennakoon, Eric I Benchimol, Zoann Nugent, M Ellen Kuenzig, Stephanie B Coward, Harminder Singh, Laura E Targownik, Sanjay K. Murthy, Charles N. Bernstein, Gilaad G. Kaplan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Disease Inflammatory bowel disease 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Internal medicine Medicine Humans Dosing Adverse effect Aged Hepatology business.industry Remission Induction Gastroenterology Manitoba Middle Aged medicine.disease Inflammatory Bowel Diseases Ulcerative colitis Penetrance Confidence interval Biological Therapy 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Corticosteroid use Female business |
| Zdroj: | The American journal of gastroenterology. 116(6) |
| ISSN: | 1572-0241 |
| Popis: | Introduction 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. Methods 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. Results 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. Discussion 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|