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P264. 30-day response to steroids predicts long term natural history of ulcerative colitis

B. Choudhury, V. Ahuja, V. Singla, S. Falodia, P. Verma, G. Makharia, H. Nikesh, S. Kumar, S. Sharma

All India Institute of Medical Sciences, New Delhi, India

Introduction: Corticosteroid is the treatment of choice in active ulcerative colitis (UC). Identification of patients at risk of corticosteroid refractory and dependency is important. The natural history of patients with UC who require corticosteroid treatment is largely unknown.

Objectives: The study evaluated if a simple clinical parameter like response at 30 days after starting steroids could predict the long term treatment outcome of steroid requiring ulcerative colitis patients.

Methods: From April 2005 to July 2009, a total of 819 patients of UC were seen in IBD clinic. Of these 284 patients received steroids. 161 patients were included in study as they completed minimum follow-up of 1 year. Demographic, clinical, and laboratory data were collected at the time of presentation. After 30 days of institution of steroids patient were classified – Complete responders, Partial responders, Non responders and the outcome were determined at 1st, 2nd, 3rd, 4th and 5th year and patient were classified in prolonged remission, corticosteroid dependent and corticosteroid refractory states.

Results: The mean age of 161 patients was 35.6±12.1 years (97 (60.2%) male and 64 (39.8%) female). The mean age at diagnosis was 32±11.5 years, mean duration of disease was 3.7±4.8 years and mean follow-up was 2.3±1.3 years. 15 (10%) had mild disease, 77 (51.33%) moderate disease and 58 (38.67%) had severe disease on presentation. 83 (51.6%) had pancolitis, 43 (26.7%) left sided colitis and 32 (19.9%) had proctitis. Of 161 UC patients initiated on oral/intravenous steroid therapy, the 30 day response was complete responders: 90 (55.9%), partial responders: 47 (29.2%) and non responders: 23 (14.3%). At the end of first year 53 of 87 complete responders maintained steroid free remission as compared to 16 of 66 incomplete responders (60.9% vs 24.4%, p < 0.001). At the end of second year, 33 of 47 complete responders maintained steroid free remission as compared to 15 of 47 incomplete responders (70.2% vs 31.9%, p < 0.001). At the end of third year 21 of 34 complete responders maintained steroid free remission as compared to 6 of 28 incomplete responders (61.7% vs 21.4%, p < 0.001). 26 (16.1%) patients develop adverse effects. 7 (4.3%) patients had tuberculosis following steroid initiation.

Conclusions: Categorizing the 30 day response after initiation of steroid therapy is a simple clinical method to determine long term course of ulcerative colitis. This study highlights a novel, easily applicable bedside concept.