Corticosteroid use and complications in a US inflammatory bowel disease cohort

Akbar K. Waljee, Wyndy L. Wiitala, Shail Govani, Ryan Stidham, Sameer Saini, Jason Hou, Linda A. Feagins, Nabeel Khan, Chester B. Good, Sandeep Vijan, Peter D R Higgins

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background and Aims 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.

Original languageEnglish (US)
Article numbere0158017
JournalPLoS One
Volume11
Issue number6
DOIs
StatePublished - Jun 1 2016

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inflammatory bowel disease
adrenal cortex hormones
Inflammatory Bowel Diseases
Adrenal Cortex Hormones
dual-energy X-ray absorptiometry
Photon Absorptiometry
Gastroenterology
veterans
Venous Thromboembolism
X rays
therapeutics
drug therapy
Patient Harm
Veterans Health
Therapeutics
United States Department of Veterans Affairs
Time and motion study
Quality of Health Care
bone density
Veterans

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Waljee, A. K., Wiitala, W. L., Govani, S., Stidham, R., Saini, S., Hou, J., ... Higgins, P. D. R. (2016). Corticosteroid use and complications in a US inflammatory bowel disease cohort. PLoS One, 11(6), [e0158017]. https://doi.org/10.1371/journal.pone.0158017

Corticosteroid use and complications in a US inflammatory bowel disease cohort. / Waljee, Akbar K.; Wiitala, Wyndy L.; Govani, Shail; Stidham, Ryan; Saini, Sameer; Hou, Jason; Feagins, Linda A.; Khan, Nabeel; Good, Chester B.; Vijan, Sandeep; Higgins, Peter D R.

In: PLoS One, Vol. 11, No. 6, e0158017, 01.06.2016.

Research output: Contribution to journalArticle

Waljee, AK, Wiitala, WL, Govani, S, Stidham, R, Saini, S, Hou, J, Feagins, LA, Khan, N, Good, CB, Vijan, S & Higgins, PDR 2016, 'Corticosteroid use and complications in a US inflammatory bowel disease cohort', PLoS One, vol. 11, no. 6, e0158017. https://doi.org/10.1371/journal.pone.0158017
Waljee AK, Wiitala WL, Govani S, Stidham R, Saini S, Hou J et al. Corticosteroid use and complications in a US inflammatory bowel disease cohort. PLoS One. 2016 Jun 1;11(6). e0158017. https://doi.org/10.1371/journal.pone.0158017
Waljee, Akbar K. ; Wiitala, Wyndy L. ; Govani, Shail ; Stidham, Ryan ; Saini, Sameer ; Hou, Jason ; Feagins, Linda A. ; Khan, Nabeel ; Good, Chester B. ; Vijan, Sandeep ; Higgins, Peter D R. / Corticosteroid use and complications in a US inflammatory bowel disease cohort. In: PLoS One. 2016 ; Vol. 11, No. 6.
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abstract = "Background and Aims 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.",
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AU - Wiitala, Wyndy L.

AU - Govani, Shail

AU - Stidham, Ryan

AU - Saini, Sameer

AU - Hou, Jason

AU - Feagins, Linda A.

AU - Khan, Nabeel

AU - Good, Chester B.

AU - Vijan, Sandeep

AU - Higgins, Peter D R

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N2 - Background and Aims 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.

AB - Background and Aims 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.

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