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Corticosteroid use and complications in a US inflammatory bowel disease cohort

Waljee, AK and Wiitala, WL and Govani, S and Stidham, R and Saini, S and Hou, J and Feagins, LA and Khan, N and Good, CB and Vijan, S and Higgins, PDR (2016) Corticosteroid use and complications in a US inflammatory bowel disease cohort. PLoS ONE, 11 (6).

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Background and Aims Corticosteroids are effective for the short- Term treatment of inflammatory bowel disease (IBD). Long- Term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid- sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Methods Retrospective review of Veterans Health Administration (VHA) data from 2002-2010. Results Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Conclusions Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Waljee, AK
Wiitala, WL
Govani, S
Stidham, R
Saini, S
Hou, J
Feagins, LA
Khan, N
Good, CBcbg15@pitt.eduCBG15
Vijan, S
Higgins, PDR
ContributionContributors NameEmailPitt UsernameORCID
Date: 1 June 2016
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: PLoS ONE
Volume: 11
Number: 6
DOI or Unique Handle: 10.1371/journal.pone.0158017
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Medicine
Refereed: Yes
Date Deposited: 23 Aug 2016 14:52
Last Modified: 13 Oct 2017 15:55


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