Intest Res.  2023 Apr;21(2):205-215. 10.5217/ir.2021.00164.

Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis

• Kobayashi T
• Udagawa E
• Hirose L
• Hibi T

• KMID: 2541893
• DOI: http://doi.org/10.5217/ir.2021.00164

Abstract

Background/Aims
Risks of long-term steroid use in patients with ulcerative colitis (UC) outweigh the benefits, thus dosing should be tapered once a response is achieved. Colonoscopy is a key technique for assessing disease severity and optimizing treatment involving steroids. This retrospective longitudinal cohort study of patients with UC explored factors associated with the duration of systemic steroid use.
Methods
The Japan Medical Data Center database, an employer-based insurance claims database, was used to select individuals initiating prednisolone, with a prescription issued between January 1, 2010, and January 31, 2018. The study included adults with a confirmed diagnosis of UC, who had received ≥1 year of continuous treatment with 5-aminosalicylic acid, biologics, or thiopurine. Factors associated with prednisolone duration were assessed using a multivariate regression model.
Results
Median duration of prednisolone treatment was 98 days, and colonoscopy was performed ≤1 month before or at the first prescription of prednisolone (index date) in 32.8% of patients (607/1,853). Shorter durations of prednisolone treatment were associated with colonoscopy ≤1 month before or at the index date and higher prednisolone dose at index date, with incidence rate ratios (IRRs) of 0.776 (95% confidence interval [CI], 0.682–0.884; P<0.001) and 0.998 (95% CI, 0.996–1.000; P=0.018), respectively. Charlson Comorbidity Index scores of 1 and ≥2 predicted longer prednisolone treatment (IRR, 1.332; 95% CI, 1.174–1.511; P<0.001 and IRR, 1.599; 95% CI, 1.357–1.885; P<0.001, respectively).
Conclusions
Performing colonoscopy before or at the time of initiating steroid was associated with a shorter duration of steroid use in patients with UC.

Keyword

Inflammatory bowel disease; Endoscopy; Drug therapy; Cohort studies; Disease management

Figure

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  Fig. 1. Flowchart of patient disposition. aPatients can be excluded due to several reasons, therefore sum of excluded patients is over the total number of excluded patients. UC, ulcerative colitis; 5-ASA, 5-aminosalicylic acid.

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  Fig. 2. Histograms of prednisolone dose at index date (mg/day) for: (A) all patients (n=1,853); (B) patients without comorbidities (excluding all cases with ICD-10 codes other than K51 [ulcerative colitis] ≤3 months from index; n=41); (C) group A (continuous prednisolone use for <3 months; n=887); (D) group B (continuous prednisolone use for ≥3 months; n=966). ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

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  Fig. 3. Multivariate regression analyses for association between patient characteristics and prednisolone treatment duration (n=1,673). CI, confidence interval.

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  Fig. 4. Multivariate regression analyses for association between patient characteristics and prednisolone treatment duration for patients that underwent colonoscopy ≤1 month before or at index date (n=571). CI, confidence interval.

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