Outcomes and prediction of corticosteroid therapy after successive courses of ulcerative colitis treatments

ABSTRACT

Background: Ulcerative colitis (UC) may require systemic corticosteroid (CS) treatment often without a reliable predictable response, except the Ho-index, used to predict severe cases. The present study aims to determine CS-efficacy and CS-free remission for different courses and longer follow-ups, and a predictive value of CS-outcomes, by the Ho-index and the analysis of clinical variables.

Methods: An observational retrospective study performed with 136 patients was based on clinical and analytical characteristics, before successive CS-therapies.

Results: The age of UC onset showed three peaks. After the first course, 55.6% were CS-responders, and 39% had CS-free remission by the 3–5-year follow-up. Successive CS-courses presented less efficacy and CS-free remissions, associated with increased CS-use dependence. The Ho-index might only predict the first course of CS and low-score patients with severe UC. Logistic regression analysis gave a predictive response mainly due to the age at diagnosis, the interval from diagnosis to CS-therapy, and C-reactive protein (CRP) or hemoglobin values.

Conclusions: One-third of the cases were CS-free remission UC. Successive courses showed decreased efficacy and increased CS-dependence, limiting CS-treatment. An older age at diagnosis, longer interval from diagnosis to CS-therapy, lower CRP and higher hemoglobin predicted better prognosis. The accuracy of prediction should be validated and include additional markers.

KEYWORDS:

• Corticosteroid
• corticosteroid-free remission
• efficacy
• predictors
• ulcerative colitis

Acknowledgments

Research awarded with the First Prize for Research in Inflammatory Bowel Disease ‘Leon Pecasse’ 2015, ACCU Cantabria-Spain. We would like to thank Dr. Kevin Dalton (Instituto Universitario de Biotecnología de Asturias, Departamento de Bioquímica y Biología Molecular, Universidad de Oviedo) for the writing assistance of the manuscript.

Declaration of interest

Sánchez has received research grants from the Ministerio de Sanidad and Educaciόn (Spain) and from the Universidad de Oviedo (Spain). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Research awarded with the First Prize for Research in Inflammatory Bowel Disease ‘Leon Pecasse’ 2015, ACCU Cantabria-Spain.