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P606 Steroid use in inflammatory bowel disease patients on biological therapy in Montenegro

B. Smolovic*1, M. Lukic1, O. Sekulic1, D. Muhovic1, V. Milosevic2, B. Vukcevic3

1Clinical Center of Montenegro, Podgorica, Montenegro, 2Ars Medica, Podgorica, Montenegro, 3Faculty of Medicine, University of Montenegro, Podgorica, Montenegro

Background

According to ECCO recommendation, corticosteroids are used in patients with ulcerative colitis (UC) and Crohn’s disease (CD) to induce remission of the disease, but do not modify the course of disease and have no role in maintaining remission. Additionally, due to the large number of side effects, long-term application of corticosteroids is not recommended.

Methods

We prospectively collected data from 110 IBD (inflammatory bowel disease) patients who had undergone biological therapy in IBD referral centre in Montenegro over 12 months. We used the online Steroid Assessment Tool (SAT), as described by Selinger et al., 2017, to record steroid use in this population of patients.

Results

In this cohort, there were 57% patients with UC and 43% patients with CD. There were 73% patients who had been administered anti-TNF biological drugs (adalimumab or infliximab), and 27% who had been administered anti-integrin therapy (vedolizumab) in the current therapy. Exposure to second anti-TNF was recorded in 23% of patients. Concomitant immunosuppressive therapy (Thiopurine and Methotrexate) was used for more than 3 months by 34 patients (30.1%). At the last measurement, 18% patients had severe and 32% patients had moderate disease activity. In the last year, 42 patients (38%) had used corticosteroids (UC 28 (44%), CD 14 (30%)) and 60% of them were taking suggested medicines for bone protection (UC 20 (71%), CD 6 (36%)). 81% of patients were found to have used one course of steroid, two courses of steroids is recorded in 14% and three courses in 5% of patients. The duration of the steroid administration was mainly observed to be 3 months (79% patients). The longest duration was 6 months and it is recorded in 1 patient.

In the sub-population of patients (42) who had used steroids, 64% (27/42) did not develop corticosteroid dependency and did not relapse after 3 months (UC 15 (54%) and CD 12 (86%)); and 36% (15/42) were found to be steroid resistant/ dependent.

In the population of steroid resistant/dependent patients (15), 67% ((10/15) (69%)UC, 1(6.7%) CD)) were not able to reduce steroid below the equivalent of prednisolone 10 mg/day (or budesonide below 3 mg/day) within 3 months of starting steroids, without recurrent active disease and had a relapse within 3 months of stopping steroids.

Conclusion

We identified inappropriate excess steroid use in 15% of patients. Excess steroid exposure was significantly higher in patients with UC compared with active CD. Routine recording of steroid dependency or excess needs to be extended to all IBD patients (particularly to UC patients) not only on biologic experienced.