Editorial | Published:

Inflammatory Bowel Disease

Past Time for Doctors to Lessen their Dependence on Corticosteroids in the Treatment of IBD

The American Journal of Gastroenterology volume 113, pages 418420 (2018) | Download Citation

Subjects

Abstract

Corticosteroids and antibodies to tumor necrosis factor (anti-TNF) are mainstays of treatment of acutely active IBD and while anti-TNF therapy is indicated for maintenance therapy, chronic corticosteroid therapy is associated with known significant risks. Nonetheless, chronic or recurrent corticosteroid treatment in IBD is common. In this edition of the journal Lewis et al. use Medicaid and Medicare databases to contrast adverse outcomes in persons with IBD and either corticosteroid or anti-TNF use. Compared to high dose corticosteroid use, anti TNF therapy is associated with less risk for death in Crohn’s disease but no statistical difference in death outcomes in ulcerative colitis. The adverse effects of corticosteroids are well known yet vigilance is still required to ensure their use is limited to the short term.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from $8.99

All prices are NET prices.

References

  1. 1.

    , , et al. Predictors and risks for death in a population based study of persons with IBD in Manitoba. Gut 2015;64:1403–1411.

  2. 2.

    , , et al. Effect of systemic corticosteroid therapy on risk for intra-abdominal or pelvic abscess in non-operated Crohn's disease. Clin Gastroenterol Hepatol 2005;3:1215–1220.

  3. 3.

    , , et al. Serious infection and mortality in patients with Crohn's disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol 2012;107:1409–1422.

  4. 4.

    , , et al. Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease. JAMA 2017;318:1679–1686.

  5. 5.

    , , et al. The incidence of cancer among patients with IBD: A population-based study. Cancer 2001;91:854–862.

  6. 6.

    , , et al. Patterns and predictors of long term nonuse of medical therapy among persons with inflammatory bowel disease. Inflamm Bowel Dis 2015;21:1615–1622.

  7. 7.

    , , et al. The rates and reasons for nonuse of prescription medication for IBD in a referral clinic. Inflamm Bowel Dis 2016;22:919–924.

  8. 8.

    , , et alIncreased mortality rates with prolonged corticosteroid therapy when compared to anti-tumor necrosis factor alpha directed therapy for inflammatory bowel disease. Am J Gastroenterol 2018;113; this issue.

  9. 9.

    , , et al. Crohn's disease patients' risk-benefit preferences: serious adverse event risks versus treatment efficacy. Gastroenterology 2007;133:769–779.

  10. 10.

    , . Infectious and malignant complications of TNF inhibitor therapy in IBD. Am J Gastroenterol. 2013;108:1835–1842.

  11. 11.

    , , et al. Prevalence of and outcomes associated with corticosteroid prescription in inflammatory bowel disease. Inflamm Bowel Dis 2014;20:622–630.

  12. 12.

    , , et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9:30–35.

  13. 13.

    , , et al. Efficacy and safety of anti-TNF therapy in elderly patients with inflammatory bowel disease. Aliment Pharmacol Ther 2015;42:441–451.

Download references

Author information

Affiliations

  1. Department of Internal Medicine, University of Manitoba IBD Clinical and Research Centre and Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    • Charles N Bernstein

Authors

  1. Search for Charles N Bernstein in:

Competing interests

Guarantor of the article: Charles Bernstein, MD.

Specific author contributions: Dr Bernstein conceived, wrote and edited the manuscript.

Financial support: None.

Potential competing interests: Charles Bernstein has consulted to Abbvie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, and Napo Pharmaceuticals and has consulted to Mylan Pharmaceuticals. He has received unrestricted educational grants from Abbvie Canada, Janssen Canada, Shire Canada, and Takeda Canada. He has been on speaker’s bureau of Abbvie Canada, Ferring Canada and Shire Canada.

Corresponding author

Correspondence to Charles N Bernstein.

About this article

Publication history

Received

Accepted

Published

DOI

https://doi.org/10.1038/ajg.2018.9