Abstract Background Systemic corticosteroids are effective in inducing remission in inflammatory bowel disease (IBD), but prolonged use is associated with limited efficacy and severe adverse effects.1 With the expansion of therapeutic options for IBD, particularly the introduction of advanced therapies, achieving corticosteroid-free remission has become an increasingly important clinical target.2,3 We aimed to study systemic corticosteroid use in patients receiving advanced therapies, to assess how different treatments influence corticosteroid reliance in routine clinical practice over a maximum follow-up period of 2 years. Methods IBD patients registered in the Dutch multicenter e-health platform IBDREAM who were treated with one or more advanced therapies between 2013 and 2025 were included.4 The advanced therapies studied comprised biologic agents (anti-TNF, anti-integrin, and anti-IL-12/23) and small molecules (JAK inhibitors). The primary outcomes were the proportion of patients who used systemic corticosteroids and the cumulative number of days of corticosteroid use during the induction phase (baseline to month 3) and the maintenance phase (month 3 to year 1 and year 1 to year 2) of advanced therapy. Secondary outcomes included budesonide use during advanced therapies. Results 1039 patients with Crohn’s disease (CD) and 509 patients with ulcerative colitis (UC) were included, with a total of 1646 and 933 advanced therapy episodes. Baseline characteristics and results are provided in Table 1 and Figure 1. In both CD and UC, vedolizumab was associated with relatively high corticosteroid use throughout both the induction and maintenance phases. In UC patients, high corticosteroid use was also observed during the induction phase of infliximab. Corticosteroid use was higher in patients with UC compared to CD, especially in the first year of treatment. Conclusion These data provide new insights into the impact of advanced therapies on corticosteroid reliance in IBD. The higher corticosteroid use observed in patients treated with vedolizumab may partially be explained by its delayed onset of effect. Increased corticosteroid use during infliximab induction may be attributable to its frequent use as first-line advanced therapy in patients with acute severe colitis, as indicated by baseline calprotectin levels. The acute nature of UC flares may also contribute to the higher corticosteroid use observed in UC compared to CD. In CD, therapies typically prescribed in later lines of treatment were associated with increased corticosteroid use, possibly due to reduced efficacy of advanced therapies in refractory patients. References: 1. Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590-599. 2. Gordon H, Minozzi S, Kopylov U, et al. ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis. 2024;18(10):1531–1555. 3. Raine T, Bonovas S, Burisch J, et al. ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. J Crohns Colitis. 2022;16(1):2–17. 4. de Jong ME, Smits LJT, van Ruijven B, et al. Increased discontinuation rates of anti-TNF therapy in elderly inflammatory bowel disease patients. J Crohns Colitis. 2020;14(7):888-895. Conflict of interest: Mr. Totté, Koen: No conflict of interest van der Esch, Hanneke: No conflict of interest Duijvestein, Marjolijn: Grant: Speaking fees from Bristol Meyers Squibb, Takeda, Galapagos, Janssen, Dr. Falk, Advisory board fees from Abbvie, Bristol Meyers Squibb, Celltrion, Galapagos/Alfasigma, Janssen, Takeda Grant/Research support: Pfizer, Bristol Meyers Squibb, Galapagos, Alfasigma, Janssen, Lilly Drenth, Joost P.H.: No conflict of interest Jansen, Jeroen Michiel: Served as a consultant for AbbVie, Janssen, Lilly, and Takeda. Mensink, Peter: No conflict of interest West, Rachel: Served as a speaker and/or an advisory board member for Ferring, Galapagos, Janssen, and Pfizer. Römkens, Tessa: No conflict of interest
Totté et al. (Thu,) studied this question.