Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis
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 long...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of Intestinal Diseases
2023-04-01
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| Series: | Intestinal Research |
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| Online Access: | http://irjournal.org/upload/pdf/ir-2021-00164.pdf |
| _version_ | 1827954112910589952 |
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| author | Taku Kobayashi Eri Udagawa Lisa Hirose Toshifumi Hibi |
| author_facet | Taku Kobayashi Eri Udagawa Lisa Hirose Toshifumi Hibi |
| author_sort | Taku Kobayashi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T14:25:08Z |
| format | Article |
| id | doaj.art-7ae2df33bad84705922f8062e81c0100 |
| institution | Directory Open Access Journal |
| issn | 1598-9100 2288-1956 |
| language | English |
| last_indexed | 2024-04-09T14:25:08Z |
| publishDate | 2023-04-01 |
| publisher | Korean Association for the Study of Intestinal Diseases |
| record_format | Article |
| series | Intestinal Research |
| spelling | doaj.art-7ae2df33bad84705922f8062e81c01002023-05-04T06:27:21ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002288-19562023-04-0121220521510.5217/ir.2021.00164988Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitisTaku Kobayashi0Eri Udagawa1Lisa Hirose2Toshifumi Hibi3 Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, JapanBackground/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.http://irjournal.org/upload/pdf/ir-2021-00164.pdfinflammatory bowel diseaseendoscopydrug therapycohort studiesdisease management |
| spellingShingle | Taku Kobayashi Eri Udagawa Lisa Hirose Toshifumi Hibi Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis Intestinal Research inflammatory bowel disease endoscopy drug therapy cohort studies disease management |
| title | Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| title_full | Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| title_fullStr | Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| title_full_unstemmed | Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| title_short | Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| title_sort | performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis |
| topic | inflammatory bowel disease endoscopy drug therapy cohort studies disease management |
| url | http://irjournal.org/upload/pdf/ir-2021-00164.pdf |
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