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Reduced Systemic Corticosteroid Use among Pediatric Patients With Inflammatory Bowel Disease in a Large Learning
Prashanthi Kandavel1, Sally J Eder2, Jeremy Adler1,2
1Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine.
Insights
Corticosteroid use in pediatric inflammatory bowel disease (IBD) has decreased significantly from 2007 to 2018. While racial disparities in use improved, variations persist, highlighting the need for continued monitoring and intervention.
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.
Objectives:
Corticosteroids have long been used to treat inflammatory bowel disease. However, cumulative corticosteroid exposure is associated with adverse effects, particularly in growing children. Professional guidelines recommend steroid-sparing strategies. It remains unknown whether corticosteroid use has decreased in children with inflammatory bowel disease.
Methods:
We performed retrospective cohort study using data from 2007 to 2018 from the international multi-center ImproveCareNow Network, a pediatric inflammatory bowel disease quality improvement collaborative. Pediatric patients diagnosed with inflammatory bowel disease were included. Patients with missing diagnosis or corticosteroid use data were excluded. We performed serial cross-sectional analyses of period prevalence and used multivariate regression models.
Results:
27,321 patients were included (65% Crohn disease, 28% ulcerative colitis, 7% indeterminate colitis). Corticosteroids were used in 10,206 (37%). Corticosteroid use decreased from 28% (2007) to 12% (2018). Black patients received corticosteroids more commonly than white patients. This disparity improved as corticosteroid use decreased in both groups. Most corticosteroid use occurred <120 days after diagnosis. Corticosteroid or 5-aminosalicylate use <120 days after diagnosis predicted later corticosteroid use. Anti-tumor necrosis factor-alpha medication use <120 days after diagnosis was associated with a reduction in corticosteroid use. As corticosteroid use decreased, steroid-sparing therapy use increased and height and weight z scores improved, particularly among children with Crohn disease. Despite improvement across the network, variation in corticosteroid usage remains.
Conclusions:
Corticosteroid use among pediatric patients with inflammatory bowel disease in the ImproveCareNow Network has decreased over time. Racial disparities in corticosteroid use were found, but gradually improved.
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