Almost 15 per cent of outpatients with inflammatory bowel disease (IBD) are being exposed to steroid doses in excess of international guidelines, according to a new UK study.
Steroid exposure was examined for outpatients attending 19 UK centres. Measures taken to avoid excess were assessed.
Of 2385 patients, 28 per cent received steroids in the preceding 12 months, 14.8 per cent of whom had steroid excess or dependency.
Furthermore, in centres (intervention centres) that introduced a local quality improvement programme to reduce steroid excess saw a significant decrease in excess dose compared with centres that did not implement the programme (exposure, 23.8% vs 31.0%; P<.001 excess vs p>
Between 2015 and 2017, steroid use fell in intervention centres (steroid exposure, 30.0%‐23.8%; P=.003; steroid excess, 13.8%‐11.5%; P=.17). Steroid excess was judged to be avoidable in 50.7 per cent.
Factors independently associated with reduced steroid excess in Crohn's disease (CD) included maintenance with anti‐tumour necrosis factor agents (odds ratio [OR], 0.61; 95% CI, 0.24‐0.95), treatment in a centre with a multi‐disciplinary team (OR, 0.54; 95% CI, 0.20‐0.86) and treatment at an intervention centre (OR, 0.72; 95% CI, 0.46‐0.97). Treatment with 5‐ASA in CD was associated with higher rates of steroid excess (OR, 1.72; 95% CI, 1.24‐2.09).
In ulcerative colitis, thiopurine monotherapy was associated with steroid excess (OR, 1.97; 95% CI, 1.19‐3.01) and treatment at an intervention centre was associated with less steroid excess (OR, 0.72; 95% CI, 0.45‐0.95).
The authors suggest that steroid use should be incorporated as a key performance indicator for the management of IBD.
The study is published in Alimentary Pharmacology & Therapeutics.