P0242 Improving quality in IBD – evaluation of corticosteroid excess prescription trends and its predictive role in disease-related outcomes
Authors: Damasceno J , Guimarães A , Carvalho T , Neves J , Arroja B , Soares J , Rebelo A , Mendes S , Gonçalves R , Leal T 
Published: January 2025

Background

Corticosteroids (CS) are effective in induction of remission in inflammatory bowel disease (IBD), but should be used sparingly, given their unfavourable safety profile. In fact, CS excess has been incorporated in quality of care standards in IBD, highlighting the importance of auditing CS use. A CS sparing strategy is frequently recommended due to risk of side effects, but its consequences in IBD outcomes have been less studied. Our primary aim was to evaluate current CS use and excess in IBD patients, and compare them with a historic cohort. Our secondary aims were to identify predictors of CS excess prescription and compare prognostic outcomes (surgery, hospitalisation, new CS cycle, structural damage and a composite outcome) at 12 months between three prescription groups (no CS use, CS use with no excess, and CS excess).

Methods

Adult outpatients with IBD were included from one trimester in 2014 and one in 2023. CS prescription trends were compared between groups. The latter group was then used to identify predictors of excess CS prescription and to compare outcomes between prescription groups.

Results

A total of 1131 outpatients with IBD were included, 374 in 2014 and 757 in 2023. CS use was significantly lower in 2023, compared to 2014 (6.4% vs 20.6%, p&lt;0.001), as was CS excess (12.0% vs 2.2%, p&lt;0.001). C reactive protein (CRP) (OR = 1.055, IC 95% 1.024-1.087, p&lt;0.001) and number of previous biologics (OR = 1.703, IC 95% 1.054-2.753, p=0.030) were independent predictors of CS excess prescription. The rates of hospitalisation, new CS cycle and composite outcome were significantly different between the 3 prescription groups (p&lt;0.001). In multivariable Cox regression, CS excess prescription was an independent predictor of hospitalisation, new CS cycle and the composite outcome. CRP and clinical activity were also independent predictors of the latter outcomes.

Conclusion

CS prescription rate has significantly decreased, possibly due to different monitoring and treatment strategies. CS excess was associated with negative outcomes, namely hospitalisation and new CS cycles. Improving quality of care in IBD should target measures to avoid excess CS prescription.

References

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