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Corticosteroid Use in Childhood-Onset Inflammatory Bowel Disease: A Nationwide Cohort Study (2006-2022)
Karl Mårild1,2, Mikkel Malham3,4, Petter Malmborg5,6,7
1Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
Insights
Corticosteroid use in pediatric IBD decreased in Crohn's disease but remained high in ulcerative colitis. Strategies are needed to reduce steroid overuse in children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Pharmacological Interventions in Pediatrics
Background:
- Corticosteroid (CS) use is prevalent in pediatric inflammatory bowel disease (PIBD), despite guidelines recommending limited use.
- The emergence of steroid-sparing therapies has not significantly reduced CS reliance in this population.
Purpose of the Study:
- To evaluate trends in corticosteroid (CS) use among children diagnosed with Crohn's disease (CD) and ulcerative colitis (UC) in Sweden.
- To identify factors associated with excess CS use in pediatric IBD patients.
Main Methods:
- A nationwide study analyzed data from 2460 CD and 2470 UC patients diagnosed between 2006 and 2022.
- Annual individual-level data on CS use, including any use and excess use (≥2 courses or ≥3 months/year), were obtained from Swedish health registers.
Main Results:
- In Crohn's disease (CD), annual CS use decreased from 42.9% in 2006 to 27.6% in 2022, with excess CS use declining from 33.7% to 19.1%.
- In ulcerative colitis (UC), annual CS use rates remained stable, with any use at 41.0% in 2006 and 43.6% in 2022, and excess use at 32.4% and 36.2%, respectively.
- Older age at diagnosis and prior IBD-related hospitalization were risk factors for excess CS use in both CD and UC.
Conclusions:
- Corticosteroid use in pediatric IBD shows a declining trend in Crohn's disease but remains persistently high in ulcerative colitis.
- These findings highlight the need for targeted strategies to mitigate excessive corticosteroid use in children with PIBD, particularly in UC.
- The study underscores the importance of monitoring CS utilization and developing effective steroid-sparing approaches in pediatric IBD management.
Background:
We aimed to determine corticosteroid (CS) use in paediatric inflammatory bowel disease (PIBD, < 18 years), which remains common despite recommendations for limited use and the emergence of steroid-sparing therapies.
Methods:
We conducted a study of all children in Sweden diagnosed with CD (n = 2460) or UC (n = 2470) in 2006-2022. Nationwide health registers provided annual individual-level data on CS use, classified as any use and excess use (i.e., ≥ 2 courses or ≥ 3 months of use per year).
Results:
The mean age at diagnosis was 13.7 (SD = 3.4) for CD and 13.9 (SD = 3.8) years for UC. In CD, the proportion of patients with any annual CS use decreased from 42.9% (2006) to 27.6% (2022; p < 0.001), particularly for excess CS use (decreasing from 33.7% to 19.1%; p < 0.001). Rates in UC remained largely unchanged, with any CS use at 41.0% in 2006 and 43.6% in 2022 (p = 0.43), while excess use was 32.4% in 2006 and 36.2% in 2022 (p = 0.21). Although any CS use was most common during the first year after diagnosis (CD: 63.8%, UC: 70.6%), annual rates stabilised only during the fourth (CD) and fifth (UC) years of diagnosis. Older age at diagnosis and prior IBD-related hospitalisation were risk factors for excess CS use in both CD and UC.
Conclusions:
The use of CS in PIBD remains high, with annual rates showing no reduction in UC over the past more than 15 years, while a marked decline is observed in CD. Our data should inform strategies to reduce excess CS use in children.
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