IBD Patients Are Taking Steroids for Too Long

A study in BMC Pharmacology & Toxicology suggests that measures in place to limit systemic steroid use for patients with inflammatory bowel disease (IBD) are not as effective as they need to be. The study authors suggest a two-part model to examine drug utilization patterns that would separately consider factors associated with initiation and duration of therapy.

Systemic steroids do not maintain disease remission for IBD patients; they are only appropriate to the induction of remission of symptoms. In addition, earlier research and real-world clinical practice has shown that many steroid-associated adverse events are duration dependent. “Approximately 10% of all reported drug adverse events in the US are associated with systemic steroids according to Healthcare Cost and Utilization Project (HCUP) analyses,” the study authors note. “Such complications are particularly costly in older patients who are at greater baseline risk.”

IBD-specific quality measures adopted by the Center for Medicare and Medicaid Services (CMS) adopted IBD-specific quality measures that call for the use of steroid-sparing maintenance regimens. But the current study, which looked at a national Medicare sample from 2006 to 2009, found that the guidelines are not being strictly adhered to. Among the 1,216 IBD patients without baseline steroid use, 21% used systemic steroids. Odds of receiving systemic steroids were greater in those younger, rural, and those receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration.

“Almost half of the patients in our study received systemic steroids which is greater than expected given that guidelines advocate systemic steroids be reserved for induction therapy and caution against numerous steroid-associated adverse events,” the researchers observed.” The findings suggest “significant” gaps and conflict with the treatment guidelines, including prolonged steroid treatment courses that potentially put patients at greater risk for the steroid-associated adverse events, including hypothalamus pituitary adrenal axis suppression, osteoporotic fractures, coronary artery disease, lipodystrophy, cataracts and potentially serious infections.

“Our results indicate the importance of separately considering drug initiation and length of treatment in identifying determinants of use,” the authors concluded. “Two part hurdle models are underutilized for examining duration of therapy in the medical literature but proved to be useful in our consideration of steroid therapy predictors. These models may have wider application to other medication utilization studies in the future.”