Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY
Taku Kobayashi, Eri Udagawa, Lisa Hirose, Toshifumi Hibi
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引用次数: 1

Abstract

Background/aims: Risks of long-term steroid use in patients with ulcerative colitis (UC) outweigh the benefits, thus dosing should be tapered once a response is achieved. Colonoscopy is a key technique for assessing disease severity and optimizing treatment involving steroids. This retrospective longitudinal cohort study of patients with UC explored factors associated with the duration of systemic steroid use.

Methods: The Japan Medical Data Center database, an employer-based insurance claims database, was used to select individuals initiating prednisolone, with a prescription issued between January 1, 2010, and January 31, 2018. The study included adults with a confirmed diagnosis of UC, who had received ≥1 year of continuous treatment with 5-aminosalicylic acid, biologics, or thiopurine. Factors associated with prednisolone duration were assessed using a multivariate regression model.

Results: Median duration of prednisolone treatment was 98 days, and colonoscopy was performed ≤1 month before or at the first prescription of prednisolone (index date) in 32.8% of patients (607/1,853). Shorter durations of prednisolone treatment were associated with colonoscopy ≤1 month before or at the index date and higher prednisolone dose at index date, with incidence rate ratios (IRRs) of 0.776 (95% confidence interval [CI], 0.682-0.884; P<0.001) and 0.998 (95% CI, 0.996-1.000; P=0.018), respectively. Charlson Comorbidity Index scores of 1 and ≥2 predicted longer prednisolone treatment (IRR, 1.332; 95% CI, 1.174-1.511; P<0.001 and IRR, 1.599; 95% CI, 1.357-1.885; P<0.001, respectively).

Conclusions: Performing colonoscopy before or at the time of initiating steroid was associated with a shorter duration of steroid use in patients with UC.

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溃疡性结肠炎患者在类固醇诱导前进行结肠镜检查可缩短类固醇的使用时间。
背景/目的:溃疡性结肠炎(UC)患者长期使用类固醇的风险大于益处,因此一旦达到缓解,剂量应逐渐减少。结肠镜检查是评估疾病严重程度和优化类固醇治疗的关键技术。这项对UC患者的回顾性纵向队列研究探讨了与全身类固醇使用时间相关的因素。方法:使用日本医疗数据中心数据库,一个基于雇主的保险索赔数据库,选择处方在2010年1月1日至2018年1月31日之间开始使用泼尼松龙的个体。该研究纳入了确诊为UC的成年人,他们接受了连续≥1年的5-氨基水杨酸、生物制剂或硫嘌呤治疗。使用多元回归模型评估与强的松龙持续时间相关的因素。结果:强的松龙治疗的中位持续时间为98天,32.8%的患者(607/ 1853)在首次使用强的松龙前≤1个月或首次使用强的松龙时(指标日期)进行了结肠镜检查。强的松龙治疗时间较短与指数日期前或指数日期≤1个月的结肠镜检查和指数日期时强的松龙剂量较高相关,发病率比(IRRs)为0.776(95%可信区间[CI], 0.682-0.884;结论:在开始使用类固醇之前或同时进行结肠镜检查与UC患者使用类固醇的持续时间较短相关。
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来源期刊
Intestinal Research
Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
7.40
自引率
10.20%
发文量
69
审稿时长
38 weeks
期刊介绍: Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.
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