Increased failure of budesonide MMX for ulcerative colitis during the COVID-19 pandemic: a population-based study
Stephanie Coward1,2, Karen J B Martins3, Scott Klarenbach3,4
1Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, AB, Canada.
Background:
Corticosteroids induce remission in ulcerative colitis (UC) but are associated with adverse effects, including prednisone ⩾20 mg/day associated with serious COVID-19 outcomes.
Objectives:
To evaluate the risk of rescue prednisone use following budesonide multimatrix system (MMX) initiation in newly diagnosed individuals with UC before and during the COVID-19 pandemic.
Design:
Population-based cohort study.
Methods:
We conducted a population-based study in Alberta, Canada, identifying adults with incident UC (2018-2022). Courses of budesonide MMX were examined for treatment failure, defined as prednisone rescue or inflammatory bowel disease-specific hospitalization within 90 days. Outcomes were compared between prepandemic (before April 2020) and pandemic periods using Cox proportional hazards models.
Results:
Among 269 dispensings of budesonide MMX (38 with multiple courses), 30.5% required rescue prednisone and 6.7% resulted in hospitalization. Budesonide MMX dispensing declined during the pandemic wherein, the hazard of prednisone rescue increased (HR 1.64; 95% CI: 1.01-2.67).
Conclusion:
Budesonide MMX was prescribed less frequently during the COVID-19 pandemic, with increased treatment failure, underscoring pandemic-related disruptions in UC management.
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