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Aliment Pharmacol Ther. 2016 Sep;44(5):482-94. doi: 10.1111/apt.13700. Epub 2016 Jul 4.

Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study.

Author information

1
Department of Gastroenterology, St George's University Hospital, London, UK.
2
Department of Primary Care and Public Health, Imperial College, London, UK.
3
Department of Gastroenterology, St James University Hospital, Leeds, UK.
4
Department of Health and Social Care Research, King's College London, London, UK.

Abstract

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-ASAs), 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-ASAs (>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-ASAs 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-ASAs. 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.

PMID:
27375210
DOI:
10.1111/apt.13700
[Indexed for MEDLINE]
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