Corticosteroid Treatment at Diagnosis: An Analysis of Relapses, Disease Extension, and Colectomy Rate in Ulcerative Colitis
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Ulcerative colitis is a chronic relapsing disease usually treated with mesalamine. The need of steroid therapy at diagnosis is generally considered as a poor prognostic factor.
The aim of our study was to assess whether patients treated with corticosteroids at diagnosis have more clinical relapses, disease progression, or an increased risk of colectomy during a 5-year follow-up.
We retrospectively evaluated patients who had received diagnosis of ulcerative colitis with a 5-year follow-up. Relapse was defined as a worsening of symptoms requiring an increase in medical treatment. Progression of disease was defined as a proximal extension of mucosal involvement, comparing the colonoscopy performed 5 years after diagnosis with the first one. The need of corticosteroid treatment at diagnosis was correlated to number of relapses, disease progression, and colectomy rate.
We included 230 patients, 116 of them (50%) treated with steroids at diagnosis. Multivariate analysis demonstrated that there is a strong correlation between corticosteroid use and number of relapses (p < 0.01), as well as with disease progression (p < 0.05). Seventeen patients (7.4%) underwent colectomy, but the correlation with steroids was not statistically significant.
These data provide evidence that the need of corticosteroids at diagnosis is associated with a worse clinical outcome.
KeywordsUlcerative colitis Disease progression Clinical relapses Corticosteroids
The authors want to thank Tommaso Cosci for the support in data collection.
LB and NdB are involved in data collection and analysis, wrote the manuscript, and approved the final version. GB, GT, EA, and MCPT performed the data collection and analysis and approved the final version. LF contributed to statistical analysis and approved the final version. MGM, LC, MB, ES, VS, SM, and FC wrote the manuscript and approved the final version.
This paper has not required funding in terms of grants, equipment, drugs
Compliance with Ethical Standards
Conflict of interest
Edoardo Savarino received lecture and Consultancy Honoraria from Takeda, Janssen, MSD, Abbvie, Sofar, Malesci, Reckitt Benckiser, Medtronic, not influencing this paper. Francesco Costa received Board Membership honoraria from Takeda, Janssen, Amgen, and lecture fees from Abbvie, Takeda, Zambon, Ferring, Diasorin, Otsuka, MSD; none of these honoraria had influence on this paper. Lorenzo Bertani, Giorgia Bodini, Maria Gloria Mumolo, Nicola de Bortoli, Linda Ceccarelli, Leonardo Frazzoni, Gherardo Tapete, Eleonora Albano, Maria Corina Plaz Torres, Massimo Bellini, Vincenzo Savarino, and Santino Marchi have no conflict of interest to declare.
This study protocol was conducted in accordance with 1975 Decl aration of Helsinki and was approved by the Ethical Committee of the University Hospital of Pisa (CEAVNO), on May 22, 2019, with the protocol number 29,124. A written informed consent was obtained from each patient included in the study.
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