title: Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort.
abstract: OBJECTIVE
  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.
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, United States of America.|Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, United States of America.
authors.forename: Wyndy L
authors.initials: WL
authors.lastname: Wiitala
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Shail
authors.initials: S
authors.lastname: Govani
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Ryan
authors.initials: R
authors.lastname: Stidham
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, United States of America.|Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Sameer
authors.initials: S
authors.lastname: Saini
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Houston VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America.|Department of Medicine, Baylor College of Medicine Medical Center, Houston, TX, United States of America.
authors.forename: Jason
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, VA North Texas Health Care System, Dallas, TX, United States of America.|Divisions of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States of America.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Feagins
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Philadelphia VA Medical Center, Philadelphia, PA, United States of America.|Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Khan
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, United States of America.|Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, United States of America.
authors.forename: Peter D R
authors.initials: PD
authors.lastname: Higgins
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062486:Public Health Surveillance; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents