Lower effectiveness of intravenous steroid treatment for moderate‐to‐severe ulcerative colitis in hospitalised patients with older onset: a multicentre cohort study
Shinji Okabayashi, Hajime Yamazaki, Keiichi Tominaga, Miki Miura, Shintaro Sagami, Katsuyoshi Matsuoka, Yoshiharu Yamaguchi, Toshihiro Noake, Keiji Ozeki, Ryosuke Miyazaki, Toshiaki Kamano, T. Fukuda, Kyoko Yoshioka, Katsuyoshi Ando, Masakatsu Fukuzawa, Akira Andoh, Yosuke Yamamoto, Toshifumi Hibi∥, Taku Kobayashi, IBD Terakoya Group
Abstract
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.