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Area of Science:

  • Gastroenterology
  • Clinical Pharmacology
  • Inflammatory Bowel Disease Research

Background:

  • Corticosteroids are key for ulcerative colitis (UC) flares.
  • Many UC patients lack response or become steroid-dependent.
  • The long-term corticosteroid response pattern in UC is not well understood.

Purpose of the Study:

  • To analyze the changing dynamics of corticosteroid response in UC patients over multiple treatment courses.
  • To identify factors influencing corticosteroid response and non-response in UC.

Main Methods:

  • Retrospective cohort study of adult UC patients (1975-2023) receiving ≥2 corticosteroid courses.
  • Treatment response assessed via Partial Mayo Score (PMS).
  • Markov modeling used to analyze response state transitions and identify associated factors.

Main Results:

  • 201 of 571 UC patients met inclusion criteria; 899 corticosteroid courses analyzed.
  • 44.3% experienced non-response and 41.8% developed steroid dependence during follow-up.
  • Non-response persistence probability was 37.8%, complete response persistence was 79.5%. Enteric infections, beclomethasone use, extraintestinal manifestations, and disease extension were significant factors.

Conclusions:

  • Corticosteroid response in UC is a dynamic process, not static.
  • A significant proportion of UC patients who initially do not respond remain unresponsive to subsequent courses.
  • Extraintestinal manifestations, corticosteroid type (prednisone vs. beclomethasone), and greater disease extension influence corticosteroid response likelihood in UC.