The recent randomised trial by Kumar et al. 1 comparing long versus short corticosteroid tapering in steroid-responsive moderate-to-severe ulcerative colitis addresses an important and understudied aspect of steroid management, particularly given the well-recognised risks of prolonged corticosteroid exposure and the resulting preference for shorter tapering strategies. While the study provides valuable prospective evidence, certain elements of interpretation and external applicability warrant further discussion. The trial was designed within a non-inferiority framework, with a prespecified margin of 10%. In this setting, interpretation is ideally anchored to the absolute difference in remission rates and its confidence interval relative to the non-inferiority boundary 2. Although the reported risk ratio suggests inferiority of the short taper in per-protocol analysis, non-inferiority and superiority are conceptually two distinct questions. Greater clarity regarding the relationship between the absolute difference and the margin would further strengthen the statistical interpretation. Although cumulative relapse rates at 6 months were similar between groups, time-to-relapse was shorter in the short-taper arm, indicating early separation of the Kaplan–Meier relapse-free survival curves with reduced separation by 6 months. Whether this reflects sustained risk reduction or predominantly a delay in relapse remains uncertain and may reflect kinetics of disease activity. Longer observation may help determine whether the curves would continue to diverge, remain parallel, or eventually converge. Distinguishing between durable benefit and temporal postponement is essential when interpreting the clinical relevance of the observed difference. The clinical implications of taper duration may also depend on the therapeutic context in which steroid tapering occurs. Co-interventions in this cohort consisted largely of mesalamine and thiopurines, without routine biologic use. However, contemporary management of ulcerative colitis increasingly emphasizes sustained steroid-free remission and earlier use of effective therapies 3-5. When steroid tapering occurs alongside biologic therapy, the relevance of prolonged corticosteroid tapering may differ from settings where slower-acting immunomodulators form the main treatment backbone. Taken together, these considerations do not diminish the value of the trial but highlight important issues in interpretation and generalizability. Further studies evaluating steroid tapering strategies within modern treatment paradigms may provide additional insight into how best to balance disease control with minimization of corticosteroid exposure. Juntao Lu: conceptualization, methodology, investigation, writing – original draft, writing – review and editing. Nik Sheng Ding: conceptualization, methodology, writing – original draft, writing – review and editing, supervision. The authors have nothing to report. The authors declare no conflicts of interest. This article is linked to Kumar et al. paper. To view this article, visit https://doi.org/10.1111/apt.70509. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Lu et al. (Tue,) studied this question.