The efficacy of corticosteroid therapy in inflammatory bowel disease: analysis of a 5-year UK inception cohort.
BACKGROUND
Corticosteroids remain the mainstay of first-line therapy in active inflammatory bowel disease.


OBJECTIVE
To determine the clinical outcome after the first corticosteroid-therapy and to identify factors which predict response/failure.


METHODS
216 (136 ulcerative colitis and 80 Crohn's disease) patients were identified in this 5-year inception cohort. The outcomes of early (30 days) and late (1 year) responses were used. Multivariate analyses were performed to identify factors associated with outcome.


RESULTS
86 (63%) and 60 (75%) ulcerative colitis and Crohn's disease required corticosteroid therapy, respectively. In ulcerative colitis, at 30 days, 69 (51%), 42 (31%) and 25 (18%) patients demonstrated complete response, partial response and no response, respectively. For Crohn's disease, these outcomes were observed in 32 (40%), 28 (35%) and 20 (25%). After 1 year, 75 (55%), 23 (17%) and 29 (21%) patients with ulcerative colitis demonstrated prolonged response, corticosteroid-dependence or required surgery, respectively. For Crohn's disease, these outcomes were observed in 30 (38%), 19 (24%) and 27 (35%) patients. Extensive ulcerative colitis was a predictor of surgery (P = 0.001, OR: 15.2). In Crohn's disease, inflammatory disease behaviour was negatively associated with surgery (P = 0.02, OR: 0.13).


CONCLUSIONS
Although corticosteroids are effective, dependence/resistance remains common. Patients with extensive ulcerative colitis and fistulizing/stricturing Crohn's are most at risk of failing corticosteroid therapy.
Ho
G-T
GT
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK. gwotzerho@aol.com
Chiam
P
P
Drummond
H
H
Loane
J
J
Arnott
I D R
ID
Satsangi
J
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones