Young Women With Ulcerative Colitis Face Higher Corticosteroid Exposure Risk

New research is providing clinicians with an overview of the prevalence of steroid use in inflammatory bowel disease (IBD) care, highlighting key groups at higher risk of exposure and identifying opportunities for reducing unnecessary exposure.1

The observational, retrospective analysis of Crohn's Colitis Care (CCCare) data suggest steroid exposure for IBD management is most common among younger individuals, females, and those with ulcerative colitis (UC), as well as individuals receiving combination immunomodulators and advanced therapies.1

“To our knowledge, this is one of the largest, contemporaneous real-world cohorts to examine steroid use in people with IBD, providing valuable insights into steroid use patterns,” Rodger Wu, MD, an IBD research fellow at Crohn's Colitis Cure and Conjoint Associate Lecturer with the University of New South Wales, and colleagues wrote.1

While steroids are commonly used in IBD management due to their high efficacy in rapid symptom reduction, adverse effects like nausea, weight gain, liver dysfunction, and increased risk of opportunistic infections limit their clinical utility. Additionally, existing research suggests use of steroids as maintenance therapy offers no benefit and instead serves as a risk factor for serious infection and death.1,2

To describe real-world patterns of corticosteroid use among people with IBD receiving routine clinical care, investigators assessed deidentified data from CCCare, a cloud-based, IBD-specific electronic medical record used in several public and private centers in Australia and New Zealand.1

Data for people with IBD under active care, defined as having had an assessment during the last 14 months, were included. For these individuals, data for the preceding 3 years were assessed.1

Steroids captured included oral prednisone, prednisolone, and budesonide, as well as intravenous methylprednisolone and hydrocortisone. Other corticosteroids not used in IBD are not captured in the IBD medication section. Investigators categorized steroid exposure based on both duration and recency. Duration was defined as short (1–28 days), moderate (29–56 days), or prolonged (> 56 days). Recency was defined as recent (within 365 days), previous (365–1085 days), or no exposure.1

Investigators assessed steroid use patterns by the number of steroid courses during the 3-year period (oral and intravenous), duration of exposure, and recency of exposure.1

The eligible cohort comprised 5436 patients, including 3136 (57.6%) with CD, 2165 (39.7%) with UC, and 135 (2.5%) with IBD-unspecified (IBD-U). Investigators noted the cohort was nearly evenly distributed in terms of sex (50.2% female) with a median age of 42 years (IQR 32–56). During the study period, 71.6% of those with CD and 50.5% of those with UC received advanced therapies.1

Overall, 994 (18.3%) people had been exposed to steroids over the preceding 3-year period, with 126 (2.3%) having prolonged and 370 (6.8%) having recent exposure, and a further 624 people (11.4%) being previously exposed.1

Upon analysis, people with CD had a lower likelihood of prolonged exposure to steroids over the study period compared to people with UC (adjusted odds ratio [AOR], 0.72; 95% CI, 0.59–0.89; P = .001). Additionally, females had a greater likelihood of both prolonged and recent exposure (AOR, 1.22; P = .048 and AOR, 1.23; P = .041, respectively).1

Investigators pointed out young adults aged 20–29 years had greater odds of prolonged and recent use than those > 70 years of age (AOR, 6.59 and 9.12, respectively; P <.001). Age at diagnosis was also found to have a modest effect size (AOR, 1.03; P <.001).1

Of note, combination immunomodulator and advanced therapy use was associated with an increased likelihood of both prolonged and recent use compared to 5-aminosalicylic acid therapy alone (AOR, 4.01; P = .002 and AOR, 4.54; P <.001).1

“These findings identify key groups at higher risk of corticosteroid exposure, including younger individuals, females and those with stoma surgery or receiving combination immunomodulators and advanced therapies,” investigators concluded.1 “In clinical practice, recognition of these subgroups should prompt early review of treatment adequacy and timely escalation to steroid-sparing agents.”

References

1. Wu R, Rivas C, Su WK, et al. Patterns and Predictors of Steroid Use in a Real-World Inflammatory Bowel Disease Cohort. JGH Open. 2025;9(12):e70308. doi:10.1002/jgh3.70308

2. Feuerstein JD, Rubin DT, Aberra FN, et al. Appropriate Use and Complications of Corticosteroids in Inflammatory Bowel Disease: A Comprehensive Review. Clinical Gastroenterology and Hepatology. doi:10.1016/j.cgh.2025.05.019