TY - JOUR
T1 - Lower effectiveness of intravenous steroid treatment for moderate-to-severe ulcerative colitis in hospitalised patients with older onset
T2 - a multicentre cohort study
AU - IBD Terakoya Group
AU - Okabayashi, Shinji
AU - Yamazaki, Hajime
AU - Tominaga, Keiichi
AU - Miura, Miki
AU - Sagami, Shintaro
AU - Matsuoka, Katsuyoshi
AU - Yamaguchi, Yoshiharu
AU - Noake, Toshihiro
AU - Ozeki, Keiji
AU - Miyazaki, Ryosuke
AU - Kamano, Toshiaki
AU - Fukuda, Tomohiro
AU - Yoshioka, Kyoko
AU - Ando, Katsuyoshi
AU - Fukuzawa, Masakatsu
AU - Andoh, Akira
AU - Yamamoto, Yosuke
AU - Hibi, Toshifumi
AU - Kobayashi, Taku
N1 - Publisher Copyright:
© 2022 John Wiley & Sons Ltd.
PY - 2022/6
Y1 - 2022/6
N2 - Background: The increasing incidence of older-onset ulcerative colitis (UC), which has a higher risk of surgery, is a global health issue. However, data regarding intravenous steroid treatment, one of the important treatment options to avoid surgery, for older-onset UC is lacking. Aims: To evaluate the association between onset age and effectiveness of intravenous steroids in UC. Methods: This retrospective multicentre (27 facilities) cohort study included moderate-to-severe hospitalised UC patients who underwent their first intravenous steroids between April 2014 and July 2019. The primary outcome was clinical remission at day 30, using two-item patient-reported outcome scoring. The key secondary outcomes were risks of surgery and adverse events (death, infection and venous thrombosis) within 90 days. A modified Poisson regression model was used for analysis. Results: Overall, 467 UC patients (384 younger-onset and 83 older-onset) were enrolled. Clinical remission at day 30 was observed in 252 (65.6%) among younger-onset patients and 43 (51.8%) among older-onset patients (adjusted risk difference, −21.7% [95% CI, −36.1% to −7.2%]; adjusted risk ratio [ARR], 0.74 [95% CI, 0.59 to 0.93]). The risks of surgery and adverse events were higher in older-onset UC (20.5% vs. 3.1%; ARR, 8.92 [95% CI, 4.13 to 19.27], 25.3% vs. 9.1%; ARR, 2.19 [95% CI, 1.22 to 3.92], respectively). Four deaths occurred, all involving older-onset UC. The risks of infection and venous thrombosis were also higher in older-onset UC (18.1% vs. 8.6%, 7.2% vs. 0.5%, respectively). Conclusions: Older-onset was associated with a lower effectiveness of intravenous steroids with higher risks of surgery and adverse events in UC.
AB - Background: The increasing incidence of older-onset ulcerative colitis (UC), which has a higher risk of surgery, is a global health issue. However, data regarding intravenous steroid treatment, one of the important treatment options to avoid surgery, for older-onset UC is lacking. Aims: To evaluate the association between onset age and effectiveness of intravenous steroids in UC. Methods: This retrospective multicentre (27 facilities) cohort study included moderate-to-severe hospitalised UC patients who underwent their first intravenous steroids between April 2014 and July 2019. The primary outcome was clinical remission at day 30, using two-item patient-reported outcome scoring. The key secondary outcomes were risks of surgery and adverse events (death, infection and venous thrombosis) within 90 days. A modified Poisson regression model was used for analysis. Results: Overall, 467 UC patients (384 younger-onset and 83 older-onset) were enrolled. Clinical remission at day 30 was observed in 252 (65.6%) among younger-onset patients and 43 (51.8%) among older-onset patients (adjusted risk difference, −21.7% [95% CI, −36.1% to −7.2%]; adjusted risk ratio [ARR], 0.74 [95% CI, 0.59 to 0.93]). The risks of surgery and adverse events were higher in older-onset UC (20.5% vs. 3.1%; ARR, 8.92 [95% CI, 4.13 to 19.27], 25.3% vs. 9.1%; ARR, 2.19 [95% CI, 1.22 to 3.92], respectively). Four deaths occurred, all involving older-onset UC. The risks of infection and venous thrombosis were also higher in older-onset UC (18.1% vs. 8.6%, 7.2% vs. 0.5%, respectively). Conclusions: Older-onset was associated with a lower effectiveness of intravenous steroids with higher risks of surgery and adverse events in UC.
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U2 - 10.1111/apt.16865
DO - 10.1111/apt.16865
M3 - Article
C2 - 35274323
AN - SCOPUS:85128750396
SN - 0269-2813
VL - 55
SP - 1569
EP - 1580
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
IS - 12
ER -