Patterns and Predictors of Steroid Use in a Real‐World Inflammatory Bowel Disease Cohort

Background Patterns of steroid use in inflammatory bowel disease remain poorly characterized in real‐world settings. Steroid exposure is associated with adverse effects and often indicates suboptimally controlled disease. Therefore, patterns and predictors of steroid use in a large inflammatory bowel disease cohort were examined. Methods Steroid exposure over a 3‐year window was explored. Use was classified by duration—short (1–28 days), moderate (29–56 days), prolonged (> 56 days), and recency (within last year, prior years or no exposure). Associations with demographic and disease‐related factors were assessed using multivariable logistic regression. Results Among 5436 people (median age 42 years, IQR 32–56), 18.3% ( n = 994) were steroid exposed. 57.6% had Crohn's disease and 50.2% were female. Crohn's disease was associated with lower odds of both prolonged and recent exposure compared to ulcerative colitis (AOR 0.72, p = 0.001 and AOR 0.78, p = 0.037, respectively). Females had a greater likelihood of both prolonged and recent exposure (AOR 1.22, p = 0.048 and AOR 1.23, p = 0.041, respectively). Young adults (20–29 years) had higher odds of prolonged and recent use than those > 70 years (AOR 6.59 and 9.12, respectively, p < 0.001). Combination immunomodulator and advanced therapy use was associated with a higher likelihood of both prolonged and recent use compared to 5‐aminosalicylic acid therapy alone (AOR 4.01, p = 0.002 and AOR 4.54, p < 0.001). Age at diagnosis had a modest effect size (AOR 1.03, p < 0.001). Conclusion Steroid use was modest, with over 80% unexposed over 3 years. Proactive optimization of therapy, particularly in younger individuals and those with ulcerative colitis, may further reduce steroid exposure.