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P421. Prevalence of steroid dependence and resistance in inflammatory bowel disease patients: treatment options as steroid-sparing agents in a single centre

C. Cassieri1, A. De Carolis1, R. Pica1, E.V. Avallone1, M. Zippi1, C. Corrado1, E.S. Corazziari1, P. Vernia1, P. Paoluzi1, 1Sapienza University, Internal Medicine and Medical Specialties, “Gastroenterology Unit”, Rome, Italy

Background

Corticosteroids (CS) have been used to treat active inflammatory bowel disease (IBD) for nearly 50 years. IBD patients are CS-dependent in 17–36% and refractory in 12–20%. Aim of the study has been to investigate the prevalence of CS dependence or resistance in a single centre series of Italian IBD patients, as well as the treatment options as CS-sparing agents in ulcerative colitis (UC) and Crohn's disease (CD).

Methods

Computerized data of consecutive IBD patients, first referred to our Centre, from 1990 to 2010, were retrospectively evaluated. CS dependence or resistance was defined according to European Crohn's and Colitis Organisation (ECCO) guidelines.

Results

One thousand three hundred and twenty-six consecutive patients were studied, 729 (55%) were male and 597 (45%) female. Of this 781 (58.9%) were affected by UC (mean age at diagnosis 36.8±15.6 SD years) and 545 (41.1%) by CD (mean age at diagnosis 42.6±14.3 SD years). Three hundred and thirty-three (25.1%) patients were CS dependent (164 UC vs 169 CD, 21% and 31% respectively, p < 0.0001); 38 (2.9%) patients were CS-resistant (19 UC vs 19 CD, 2.4% and 3.5% respectively). Of this 63 patients with a follow-up <12 months were excluded from the study. Three hundred and eight patients (146 UC, 162 CD) were evaluated for treatment options as CS-sparing agents (mean follow-up of 72.4±59.9 SD months, range 12–323 months). One hundred and ninety-one patients were treated with Azathioprine (85 UC vs 106 CD), 32 underwent surgery (6 UC vs 26 CD, p = 0.0006), 16 were treated with anti TNF-α agents (8 UC vs 8 CD), 13 with Cyclosporine (2 UC vs 11 CD, p = 0.0220), 4 with Methotrexate (3 UC vs 1 CD), 9 UC patients were treated with leukocytapheresis. Forty-three patients (33 UC vs 10 CD, p < 0.0001) refused other therapeutic options and continued on CS.

Conclusion

The prevalence of CS-dependence was significantly higher in CD than in UC. Cyclosporine and surgery were significantly used in CD than UC. AZA was the more prescribed treatment to avoid a long-term use of CS. Interestingly that a higher number of patients refused treatment options to sparing CS.