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Corticosteroid Sparing in Inflammatory Bowel Disease is More Often Achieved in the Immunomodulator and Biological Era—Results from the Dutch Population-Based IBDSL Cohort

Jeuring, Steven F G MD1,2; Biemans, Vince B C MD1; van den Heuvel, Tim R A PhD1,2; Zeegers, Maurice P PhD2,3; Hameeteman, Wim H MD, PhD1,2; Romberg-Camps, Mariëlle J L MD, PhD4; Oostenbrug, Liekele E MD, PhD5; Masclee, Ad A M MD, PhD1,2; Jonkers, Daisy M A E PhD1,2; Pierik, Marieke J MD, PhD1,2

American Journal of Gastroenterology: March 2018 - Volume 113 - Issue 3 - p 384–395
doi: 10.1038/ajg.2017.482
ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE
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OBJECTIVES: Corticosteroid-free remission is an emerging treatment goal in the management of inflammatory bowel disease (IBD). In the population-based Inflammatory Bowel Disease South Limburg cohort, we studied temporal changes in corticosteroid use and assessed the corticosteroid-sparing effects of immunomodulators and biologicals in real life.

METHODS: In total, 2,823 newly diagnosed patients with Crohn's disease (CD) or ulcerative colitis (UC) were included. Corticosteroid exposure and cumulative days of use were compared between patients diagnosed in 1991–1998 (CD:n=316, UC:n=539), 1999–2005 (CD:n=387, UC:n=527), and 2006–2011 (CD:n=459, UC:n=595). Second, the corticosteroid-sparing effects of immunomodulators and biologicals were assessed.

RESULTS: Over time, the corticosteroid exposure rate was stable (54.0% in CD and 31.4% in UC), even as the cumulative corticosteroid use in the first disease year (CD: 83 days (interquartile range (IQR) 35–189), UC: 62 days (IQR 0–137)). On the long-term, a gradual decrease in cumulative corticosteroid use was seen in CD (era '91–'98: 366 days (IQR 107–841), era '06–'11: 120 days (IQR 72–211),P<0.01), whereas in UC an initial decrease was observed (era '91–'98: 184 days (IQR 86–443), era '99–'05: 166 days (IQR 74–281),P=0.03), and stabilization thereafter. Immunomodulator and biological users had a lower risk of requiring corticosteroids than matched controls in CD only (33.6% vs. 49.9%,P<0.01, and 25.7% vs. 38.2%,P=0.04, respectively).

CONCLUSIONS: In a real-world setting, more recently diagnosed IBD patients used lower amounts of corticosteroids as of the second year of disease. For CD, a significant association was found with the use of immunomodulators and biologicals. These conclusions support the increasing use of these treatment modalities.

1Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

2School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands

3Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands

4Department of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

5Department of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Center, Heerlen, The Netherlands

Correspondence: Steven F.G. Jeuring, MD, Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Postbox 5800, Maastricht AZ 6202, The Netherlands. E-mail: steven.jeuring@maastrichtuniversity.nl

published online 9 January 2018

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A300

Received 3 July 2017; accepted 14 November 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
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