Reducing Steroid Treatment at Week 4 Beneficial for Ulcerative Colitis Patients

Reducing steroid use in patients with ulcerative colitis at week 4 ultimately could result in a total discontinuation of the treatment down the line.

A team, led by Masataka Masuda, Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, assessed trends in steroid use and the effects of the initial dose, duration of use, and tapering schedule on clinical efficacy in patients with ulcerative colitis undergoing steroid treatment.

Treatments for Ulcerative Colitis

There are a wide range of therapeutic treatments for ulcerative colitis, including 5-aminosalicylic acids (5-ASAs), corticosteroids, thiopurine, calcineurin inhibitors, antitumor necrosis factor (TNF)-α antibody, Janus kinase inhibitor, anti-a4b7 integrin antibody, and anti-IL-12/23 antibody.

However, 5-ASA and corticosteroids remain the fundamental medications for treating patients with active ulcerative colitis.

“Steroid treatment is considered for patients with more severe symptoms when 5-ASAs are not effective in inducing remission, or for hospitalized patients with acute severe UC,” the authors wrote. “Although the effectiveness of corticosteroids is clear, due to potential adverse events, caution should be exercised with steroid use.”

Most guidelines recommend a dose of 40-60 mg per day in hospitalized patients.

Reducing Steroid Use

In the study, the investigators examined 191 patients with ulcerative colitis who underwent steroid treatment between 2006-2020. The investigators assessed the difference in clinical remission rates in patients with different initial doses of steroid treatment, as well as clinical factors for clinical remission at week 4 and discontinuation of corticosteroid within 12 weeks.

The results show 56% (n = 107) of patients were in clinical remission at week 4, while 30.4% (n = 58) had a clinical response at week 4.

However, there were some trends found for hospitalized patients.

For example, the male sex(OR, 0.373; 95% CI, 0.146–0.956) and younger age (OR, 0.974; 95% CI, 0.951–0.998) were associated with clinical remission at week 4.

For outpatients, partial Mayo score (OR, 0.643; 95% CI, 0.451–0.918) and initial steroid dose of at least 30 mg (OR, 3.278; 95% CI, 1.274–8.435) were associated with clinical remission at week 4.

In addition, clinical remission at week 4 (OR, 0.300; (95% CI, 0.126–0.718)) and the steroid dose reduction rate at week 4 (OR, 0.092; 95% CI, 0.036–0.234) were linked to medication discontinuation within 12 weeks.

The proportion of patients that discontinued corticosteroids at week 12 was significantly higher (P = 0.006) between 2016–2020 (n = 28; 53.8%) than it was between 2006–2010 (n = 15; 27.8%).

“The steroid reduction rate at week 4 may be critical for discontinuation within 12 weeks,” the authors wrote. “Withdrawal of corticosteroids has been becoming more appropriate in the last 5 years than before.”

The study, "Analysis of the initial dose and reduction rate of corticosteroid for ulcerative colitis in clinical practice," was published online in JGH Open.