Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form
D-Scholarship @ Pitt Banner and Links to Homepage

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).

[img]
Preview
 PDF
Published Version
Available under License : See the attached license file.
Download (1MB)
[img] Plain Text (licence)
Available under License : See the attached license file.
Download (1kB)

Abstract

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.

Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
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
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorCominelli, FabioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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
URI: http://d-scholarship.pitt.edu/id/eprint/28361

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com

Actions (login required)

View Item View Item