Tapering steroids by fourth week benefits ulcerative colitis patients: Study

JAPAN: Reducing steroid use in ulcerative colitis patients at week 4 may eventually lead to a complete end to treatment, states a study published in the Journal of Gastroenterology and Hepatology.

Although the etiology of Ulcerative Colitis is unknown, the pathophysiology of UC has been widely investigated and involves host genetic factors, immune system dysregulation, and environmental factors. For ulcerative colitis, a variety of therapeutic approaches are available, including 5-aminosalicylic acids (5-ASAs), corticosteroids, thiopurine, calcineurin inhibitors, anti-tumor necrosis factor (TNF)- antibody, Janus kinase inhibitor, anti-a4b7 integrin antibody, and anti-IL-12/23 antibody. Yet, 5-ASA and corticosteroids continue to be the cornerstone drugs for treating those with active ulcerative colitis.

The authors analyzed steroid treatment trends and the impact of the initial dose, length of usage, and tapering schedule on clinical efficacy in ulcerative colitis patients.

The researchers looked at 191 ulcerative colitis patients who had steroid therapy between 2006 and 2020. The researchers evaluated clinical determinants for clinical remission at week 4 and termination of corticosteroid within 12 weeks, as well as the differences in clinical remission rates in individuals with various baseline steroid treatment doses.

Key findings of the study:

• At week 4, 107 (56.0%) cases had achieved clinical remission, whereas 58 cases had demonstrated a response.
• At week four, clinical remission in hospitalized patients was associated with male sex (odds ratio [OR], 0.373; 95% confidence interval [CI], 0.146-0.956) and younger age (OR, 0.974; 95% CI, 0.951-0.998).
• A partial Mayo score and an initial steroid dose of less than 30 mg were linked to clinical remission in outpatients at week four (OR, 0.643, and OR, 3.278, respectively).
• Treatment cessation within 12 weeks was linked with clinical remission at week 4 (OR, 0.300) and the rate of steroid dose reduction at week 4 (OR, 0.092).
• The percentage of patients who had their corticosteroid treatment stopped at week 12 was substantially greater in the period from 2016 to 2020 (28/52; 53.8%) than it was in the period from 2006 to 2010 (15/54; 27.8%).

"In the last five years, stopping corticosteroids has become more prudent than it was in the past", added the researchers.

The authors concluded that for cessation within 12 weeks, the pace of steroid reduction at week 4 can be crucial.

REFERENCE

Masuda, M., Fukata, N., Sano, Y., Nishimon, S., Aoi, M., Tomiyama, T., Fukui, T., Omiya, M., Okazaki, K. and Naganuma, M. (2022), Analysis of the initial dose and reduction rate of corticosteroid for ulcerative colitis in clinical practice. JGH Open. https://doi.org/10.1002/jgh3.12796