Background: Corticosteroids induce remission in ulcerative colitis (UC) but are associated with adverse effects, including prednisone ⩾20 mg/day associated with serious COVID-19 outcomes. Objectives: To evaluate the risk of rescue prednisone use following budesonide multimatrix system (MMX) initiation in newly diagnosed individuals with UC before and during the COVID-19 pandemic. Design: Population-based cohort study. Methods: We conducted a population-based study in Alberta, Canada, identifying adults with incident UC (2018–2022). Courses of budesonide MMX were examined for treatment failure, defined as prednisone rescue or inflammatory bowel disease-specific hospitalization within 90 days. Outcomes were compared between prepandemic (before April 2020) and pandemic periods using Cox proportional hazards models. Results: Among 269 dispensings of budesonide MMX (38 with multiple courses), 30.5% required rescue prednisone and 6.7% resulted in hospitalization. Budesonide MMX dispensing declined during the pandemic wherein, the hazard of prednisone rescue increased (HR 1.64; 95% CI: 1.01–2.67). Conclusion: Budesonide MMX was prescribed less frequently during the COVID-19 pandemic, with increased treatment failure, underscoring pandemic-related disruptions in UC management.
Coward et al. (Sun,) studied this question.