P0850Nationwide variability in steroid tapering and adrenal insufficiency management in paediatric Inflammatory Bowel Diseases: results from an Italian survey

Background Although paediatric inflammatory bowel diseases (PIBD) are increasingly managed with steroid-sparing strategies, corticosteroids remain widely used. Their use is heterogeneous, with tapering regimens largely empirical. In 2024, endocrinology guidelines on glucocorticoid-induced adrenal insufficiency (AI) were published, yet disease-specific recommendations for PIBD are lacking1. This study aimed to assess nationwide approaches to steroid tapering and AI management. Methods A cross-sectional survey was conducted among Italian PIBD centres (11/2024–02/2025)2 using a structured questionnaire completed by one clinician per centre. Centres were defined as high-volume if managing ≥100 PIBD patients. Denominators represent the number of respondents per question. Results Thirty-four centres responded, collectively caring for >4300 PIBD patients, including 18 high-volume centres. Regarding prednisone/prednisolone, 5/31 (16%) and 4/31 (13%) reported routinely maintaining full-dose therapy for 3 and 4 weeks, respectively; 3/31 (10%) extended full-dose treatment beyond 4 weeks in 10–25% of cases. Tapering durations >10 weeks occurred in ≤ 25% of cases in 15/30 (50%) centres (Figure 1). Second-generation steroids were routinely tapered in 19/30 (budesonide), 14/30 (budesonide-MMX) and 13/30 (beclomethasone) centers (Figure 2). In 14/31 (45%) centres, AI risk was never evaluated after corticosteroid cessation, while only 4/31 (13%) assessed it always or in ≥ 75% of cases. Guideline-based tapering was considered sufficient for AI risk management by 20/31 (64%) centers. Among the 9/31 (29%) centres evaluating AI risk in ≥ 25% of patients, 3 routinely assessed the hypothalamic–pituitary–adrenal axis and 5 tapered steroids gradually below the physiologic threshold. Patient education on steroid adverse events, including AI and withdrawal syndrome, was routinely provided in 22/30 (73%) centres, with significant differences between high- and low-volume sites (15/18 [83%] high-volume centers vs 7/16 [44%] low-volume centers, p < 0.05). Conclusion This nationwide survey reveals marked heterogeneity in corticosteroid tapering among Italian PIBD centres, with prolonged regimens still commonly used. Notably, the evaluation and management of AI risk remains inconsistent and often overlooked. These findings underscore the urgent need for disease-specific, evidence-based guidelines to harmonise practice and improve patient safety. References: 1 Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. Eur J Endocrinol. 2024;190(5):G25-G51. doi:10.1093/ejendo/lvae029 2 Gianolio Laura1, Bramuzzo Matteo2, Labriola Flavio3, Aloi Marina4, Alvisi Patrizia3, Arrigo Serena5, Banzato Claudia6 Bentivoglio Vincenzo Pio7, Brusaferro Andrea8, Buccella Valentina9, Caimmi Silvia10, Civitelli Fortunata11, Colucci Antonio12, Corpino Mara13, Сozzali Rita14, Di Nardo Giovanni15, Difrancisca Elvira16, Dipasquale Valeria17 Faraci Simona18, Felici Enrico19, Gaio Paola20, Gatti Simona21, Graziano Francesco22, Imondi Chiara18, Isoldi Sara23, Iuliano Silvia24, Lega Sara2, Mainetti Martina25, Marseglia Antonio26, Martelossi Stefano27, Martinelli Massimo28, Melli Paola29, Opramolla Anna30, Renzo Sara31, Sansotta Naire32, Scarallo Luca31, Sgaramella Paola33, Zuin Giovanna34, Norsa Lorenzo1 - 1Department of Paediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy 2Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy. 3Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy. 4Pediatric Gastroenterology, Hepatology and Cystic Fibrosis Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy. 5Pediatric Gastroenterology and Endoscopy Unit, IRCCS Giannina Gaslini, Genova, Italy. 6Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy. 7Paediatric Gastroenterology Unit, San Bortolo Hospital, Vicenza, Italy 8Department of Paediatrics, “S. Giovanni Battista” Hospital, Foligno, Italy 9 U.O.M. Pediatria, Ospedale Santa Chiara, Trento, Italy. 10Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 11Department of Gender diseases, Child and Adolescent health, Pediatric unit, Sant’ Eugenio Hospital, Rome, Italy. 12Department of Woman, Child and General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy 13Ospedale Pediatrico Microcitemico A. Cao, ARNAS Brotzu, Cagliari, Italy. 14University of Perugia, Perugia, Italy. 15Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Pediatric Unit, Sant’Andrea University Hospital, Rome, Italy. 16ARNAS Civico, Palermo, Italy. 17Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy. 18Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, Rome, Italy 19 Pediatric and Pediatric Emergency Unit, Children Hospital, AOU SS Antonio e Biagio e C. Arrigo, Alessandria, Italy 20Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women’s and Children’s Health, University Hospital of Padova, Padua, Italy 21Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy 22 Villa Sofia Cervello Hospital, Pediatric Unit, Palermo, Italy 23 Santobono-Pausilipon Children’s Hospital, Naples, Italy. 24 Gastroenterology and Digestive Endoscopy Unit, University of Parma, Parma, Italy 25Santa Maria delle Croci Hospital, Ravenna, Italy. 26IRCCS “Casa Sollievo della Sofferenza,” San Giovanni Rotondo, Italy 27”Ca’ Foncello” Hospital, Treviso, Italy. 28Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”. 29Division of Pediatrics, Department of Medicine (DAME) University of Udine Udine Italy. 30Regina Margherita Children’s Hospital, Turin, Italy. 31University of Florence-Gastroenterology and Nutrition Unit, Meyer Children’s Hospital, IRCCS, Florence, Italy 32Pediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy 33Department of Paediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy. 34Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy Conflict of interest: Dr. Gianolio, Laura: No conflict of interest Gaboardi, Francesca: No conflict of interest Bramuzzo, Matteo: No conflict of interest Labriola, Flavio: No conflict of interest Norsa, Lorenzo: No conflict of interest