Short-Term Clinical Response to Corticosteroids Can Predict Long-Term Natural History of Ulcerative Colitis: Prospective Study Experience.
Long-term outcome and natural history of steroid response in adult ulcerative colitis patients based on short-term response is largely unknown.



To evaluate whether short-term clinical response at 30  days after steroid initiation for moderate to severe disease can predict long-term outcome.



This prospective observational study recruited 161 patients who received oral/intravenous steroid therapy at our institution from April 2005 to July 2009. Short-term response at 30 days and long-term response at the end of first and third years were measured. Risk factors for long-term outcome at 1 and 3 years were analyzed by multivariate regression model.



At the end of 30 days, 90 patients (55.9%) had complete response, 47 (29.2%) partial response, and 24 (14.9%) did not respond at all. At the end of first year, 53/90 (60%) complete responders (at 30 days) maintained steroid-free remission when compared to 17/71 (23.9%, p < 0.001) partial/no responders. Similar result was observed at the end of third year (74.7 vs 55.1%, p = 0.017). On multivariable analysis, short-term outcome at 30 days was a predictor of outcome at the end of one year (RR 4.1, 95% CI 2.2-8.5) and 3 years (RR 2.1, 95% CI 1.02-4.5).



Short-term response to steroids is a strong predictor of long-term outcome at 1 and 3 years in active ulcerative colitis patients.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Tarun
T
Rai
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Bikash Narayan
BN
Choudhury
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Saurabh
S
Kedia
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Sawan
S
Bopanna
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Pratap Mouli
PM
Venigalla
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Sushil Kumar
SK
Garg
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Vikas
V
Singla
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India.
Govind
G
Makharia
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India. vins_ahuja@hotmail.com.
Vineet
V
Ahuja
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones
Corticosteroids; Hydrocortisone; Inflammatory bowel disease; Prednisone; Ulcerative colitis