S885 Inflammatory Bowel Disease Flare Outcomes After Corticosteroid Therapy: A Single Center Retrospective Analysis

Field: Medicine (Health Sciences)

Introduction: In the pre-biologic era, population-based data from Olmsted County, MN (Faubion and colleagues) demonstrated high rates of corticosteroid persistence and colectomy for ulcerative colitis (UC) patients started on corticosteroid therapy. We present a single-center retrospective analysis in a racially diverse population to study their short and long-term outcomes following the administration of corticosteroids for UC among patients at high risk for colectomy who required admission along with the impact of sociodemographic and clinical factors on their outcomes. Methods: We analyzed medical records of patients hospitalized for a UC flare to Montefiore Medical Center from January 1, 2015, until January 1, 2020, who were treated with systemic corticosteroids. Outcomes were measured as short term (30 days) or long term (1 year) following the admission. Demographic variables were abstracted. We identified patients at the short term that achieved complete clinical remission (total regression of clinical symptoms), partial remission (≤4 stools/day; blood, pus, mucus in feces; or abdominal pain, and no systemic symptoms), and no clinical response as defined in Faubion, et al. We also determined which patients were corticosteroid-free, corticosteroid persistent, and those who underwent colectomy due to active disease at 1-year. Independent variable association between 30 day and 1-year outcomes were assessed by multivariate logistic regression. Results: 81 patients with UC were identified. Sociodemographic variables are shown in Figure. Overall, 68/81 (84%) achieved complete clinical remission, 9/81 (11%) partial remission, and 4/81 (5%) did not respond to systemic corticosteroids. 68/81 (84%) were corticosteroid-free at 1 year. 11/81 (13%) remained on corticosteroids, and 2/81 (3%) underwent colectomy at 1 year. Additionally, TNF alfa inhibitors (27%), and anti-integrins (15%) were started after or as the corticosteroids were discontinued. The multivariable analysis did not show any association between sociodemographic factors and outcomes of interest (Table). Conclusion: Rates of corticosteroid persistence and colectomy are different than previously reported in the pre-biologic era with only 13% and 3% at 12 months respectively. Our results differ significantly from Faubion and colleagues suggesting overall changes in IBD care since that publication. No association was observed among racial/ethnicity, insurance type, and short and long-term outcomes of interest.Figure 1.: Sociodemographic variables Table 1. - Multivariate logistic regression among short term (30 days) and long term (1-year) end point and sociodemographic variables 30 days end point Odds ratio (OR) Confidence Interval (CI) No remission 3.18 0.11-6.3 Sex Partial 0.62 -1.70-2.9 Complete 2.56 0.42-4.7 No remission 0.39 -0.32-1.1 Race /Ethnicity Partial 2.2 -0.71-5.1 Complete 0.09 -0.34-0.52 No remission -0.46 -3.24-2.32 Insurance type Partial 0.20 -1.21-1.60 Complete 0.27 -0.95-1.48 No remission 0.08 0.003-0.15 Age Partial 4.16 0.49-7.83 Complete 0.044 0.01-0.1 No remission -1.35 -11.96-9.3 IBD location Partial -0.13 -2.6-2.36 Complete 1.11 -0.96-3.2 1 year end point Odds ratio (OR) Confidence Interval (CI) Prolonged remission 0.6 -0.68-1.88 Sex Corticosteroid persistent -0.9 -2.90-1.1 Surgical resection (Colectomy) -15.3 -3173-3142 Prolonged remission 0.28 -0.61-1.17 Race/ Ethnicity Corticosteroid persistent 2.7 -1.05-6.48 Surgical resection (Colectomy) 0.28 -0.61-1.17 Prolonged remission -0.16 -1.8-1.5 Insurance type Corticosteroid persistent 0.25 -1.51-2.0 Surgical resection (Colectomy) -1.18 -5.1-2.7 Prolonged remission 0.015 -0.02-0.05 Age Corticosteroid persistent 1.61 -1.55-4.8 Surgical resection (Colectomy) 0.003 -0.07-0.08 Prolonged remission 1.45 -0.03-2.9 IBD location Corticosteroid persistent 6.56 -4.96-18.1 Surgical resection (Colectomy) 1.13 -1.47-3.7