Declining Corticosteroid Use for Inflammatory Bowel Disease Across Alberta: A Population-Based Cohort Study

Area of Science:

• Gastroenterology
• Clinical Epidemiology
• Health Services Research

Background:

• Corticosteroid-free remission is a key treatment objective in inflammatory bowel disease (IBD).
• Anti-tumor necrosis factor (anti-TNF) therapies are increasingly utilized to achieve this goal.
• Understanding temporal trends in IBD management is crucial for optimizing patient care.

Purpose of the Study:

• To analyze trends in corticosteroid use, anti-TNF therapy adoption, hospitalization, and surgery rates in a prevalent IBD cohort in Alberta, Canada.
• To identify geographic and age-related disparities in IBD care.
• To assess the impact of increased anti-TNF use on corticosteroid dependence.

Main Methods:

• Utilized health administrative data from 2010 to 2015 for individuals with IBD.
• Employed log-binomial and log-linear regression models to analyze temporal trends in medication dispensing, hospitalizations, and surgeries.
• Stratified analyses by geographic location (metropolitan vs. non-metropolitan) and age cohorts.

Main Results:

• Corticosteroid use and dependence significantly decreased in both metropolitan and non-metropolitan areas.
• The proportion of individuals receiving anti-TNF therapy increased substantially over the study period.
• Hospitalizations were higher in non-metropolitan areas, while surgery rates were similar between groups. Corticosteroid dependence was higher in UC vs. CD and in pediatric vs. adult/elderly cohorts.

Conclusions:

• Increased utilization of anti-TNF therapy is associated with a decline in corticosteroid use and dependence among IBD patients.
• Significant healthcare inequities in IBD management persist, particularly concerning geographic location and age.
• Further research is needed to address these disparities and ensure equitable access to optimal IBD care.