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Steroid dependency and trends in prescribing for inflammatory bowel disease – a 20‐year national population‐based study
Author(s) -
Chhaya V.,
Saxena S.,
Cecil E.,
Subramanian V.,
Curcin V.,
Majeed A.,
Pollok R. C.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13700
Subject(s) - medicine , inflammatory bowel disease , dependency (uml) , inflammatory bowel diseases , population , steroid , disease , intensive care medicine , environmental health , systems engineering , hormone , engineering
Summary Background It is unclear whether adherence to prescribing standards has been achieved in inflammatory bowel disease ( IBD ). Aim To determine how prescribing of 5‐aminosalicylates (5‐ ASA s), steroids and thiopurines has changed in response to emerging evidence. Methods We examined trends in oral and topical therapies in 23 509 incident IBD cases (6997 with Crohn's disease and 16 512 with ulcerative colitis) using a nationally representative sample between 1990 and 2010. We created five eras according to the year of diagnosis: era 1 (1990–1993), era 2 (1994–1997), era 3 (1998–2001), era 4 (2002–2005) and era 5 (2006–2010). We calculated the proportion of patients treated with prolonged 5‐ ASA s (>12 months) and steroid dependency, defined as prolonged steroids (>3 months) or recurrent (restarting within 3 months) steroid exposure. We calculated the cumulative probability of receiving each medication using survival analysis. Results Half of the Crohn's disease patients were prescribed prolonged oral 5‐ ASA s during the study, although this decreased between era 3 and 5 from 61.8% to 56.4% ( P = 0.002). Thiopurine use increased from 14.0% to 47.1% ( P < 0.001) between era 1 and 5. This coincided with a decrease in steroid dependency from 36.5% to 26.8% ( P < 0.001) between era 1 and 2 and era 4 and 5 respectively. In ulcerative colitis, 49% of patients were maintained on prolonged oral 5‐ ASA s. Despite increasing thiopurine use, repeated steroid exposure increased from 15.3% to 17.8% ( P = 0.02) between era 1 and 2 and era 4 and 5 respectively. Conclusions Prescribing in clinical practice insufficiently mirrors the evidence base. Physicians should direct management towards reducing steroid dependency and optimising 5‐ ASA use in patients with IBD .