Reduced Systemic Corticosteroid Use among Pediatric Patients With Inflammatory Bowel Disease in a Large Learning...

Area of Science:

• Pediatric Gastroenterology
• Inflammatory Bowel Disease Research
• Pharmacological Treatment Outcomes

Background:

• Corticosteroids are a common treatment for pediatric inflammatory bowel disease (IBD).
• Long-term corticosteroid exposure poses significant risks, especially for children's growth and development.
• Guidelines advocate for steroid-sparing strategies in pediatric IBD management.

Purpose of the Study:

• To investigate trends in corticosteroid use among children with IBD.
• To identify factors associated with corticosteroid use and disparities.
• To assess the impact of changing corticosteroid use on patient outcomes.

Main Methods:

• Retrospective cohort study utilizing data from the ImproveCareNow Network (2007-2018).
• Inclusion of pediatric patients diagnosed with IBD, excluding those with missing data.
• Serial cross-sectional analyses and multivariate regression models to analyze corticosteroid prevalence and predictors.

Main Results:

• Corticosteroid use in pediatric IBD patients decreased from 28% in 2007 to 12% in 2018.
• Black patients initially had higher corticosteroid use, but this disparity lessened as overall use declined.
• Early use of anti-tumor necrosis factor-alpha therapy was linked to reduced corticosteroid use, while early corticosteroid or 5-aminosalicylate use predicted later corticosteroid dependence.

Conclusions:

• Corticosteroid use in pediatric IBD patients within the ImproveCareNow Network has significantly decreased over a decade.
• Improvements in steroid-sparing therapies correlated with better growth outcomes, particularly in Crohn disease.
• Despite overall progress, variations in corticosteroid prescribing practices persist across the network.