Prevalence of Corticosteroids Use and Disease Course After Initial Steroid Exposure in Ulcerative Colitis

Background Limited nationwide data currently exists regarding corticosteroid (CS) use and long-term outcome after CS initiation in ulcerative colitis (UC). Aims 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. Methods 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. Results 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. Conclusions 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.