Trends in Corticosteroid Use and Excess in Patients With Inflammatory Bowel Disease in the United States, Sweden, and Denmark

Background and Aims Studies show that corticosteroid use in inflammatory bowel disease (IBD) exceeds guideline recommendations. To better understand patterns of corticosteroid use and identify factors associated with excess exposure, we examined long‐term trends in corticosteroid prescribing practices in large IBD populations across 3 countries. Methods This retrospective analysis used data from US administrative claims (2007–2018) and national registries from Sweden (2006–2022) and Denmark (1995–2018). The prevalent cohort included patients with ≥ 2 records of an IBD diagnosis since data collection. The incident cohort included patients with a new IBD diagnosis. Excess corticosteroid use was defined as ≥ 2 separate corticosteroid courses within 1 year and/or continuous corticosteroid exposure ≥ 3 months. We conducted multivariable logistic regression to identify variables associated with excess use. Results In prevalent cohorts, including 257,359 (United States), 75,301 (Sweden), and 46,785 (Denmark) patients, annual rates of corticosteroid use and excess declined over the study period in the United States (use: CD [28.1 → 26.4%], UC [31.6 → 27.5%]; excess: CD [13.7 → 11.3%], UC [16.9% → 11.8%]), Sweden (use: CD [29.8% → 20.9%], UC [21.5% → 14.8%]; excess: CD [22.8% → 15.2%], UC [14.8% → 9.5%]), and Denmark (use: CD [15.5% → 10.0%], UC [12.1% → 8.5%]; excess: CD [6.8% → 3.2%], UC [4.9% → 2.5%]). In incident cohorts, including 106,845 (United States), 45,347 (Sweden), and 37,681 (Denmark) patients, corticosteroid use and excess were highest during the first year post‐diagnosis. During years 2‐4 post‐diagnosis, IBD complications, IBD‐related hospitalizations, and previous advanced therapy exposure (excluding CD Danish cohort) were associated with excess use. Conclusions Corticosteroid use decreased over time, though exposure varied across countries. Corticosteroid use and excess were highest during the first year after diagnosis.