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Short-Term Clinical Response to Corticosteroids Can Predict Long-Term Natural History of Ulcerative Colitis: Prospective Study Experience

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Abstract

Background

Long-term outcome and natural history of steroid response in adult ulcerative colitis patients based on short-term response is largely unknown.

Aim

To evaluate whether short-term clinical response at 30  days after steroid initiation for moderate to severe disease can predict long-term outcome.

Methods

This prospective observational study recruited 161 patients who received oral/intravenous steroid therapy at our institution from April 2005 to July 2009. Short-term response at 30 days and long-term response at the end of first and third years were measured. Risk factors for long-term outcome at 1 and 3 years were analyzed by multivariate regression model.

Results

At the end of 30 days, 90 patients (55.9%) had complete response, 47 (29.2%) partial response, and 24 (14.9%) did not respond at all. At the end of first year, 53/90 (60%) complete responders (at 30 days) maintained steroid-free remission when compared to 17/71 (23.9%, p < 0.001) partial/no responders. Similar result was observed at the end of third year (74.7 vs 55.1%, p = 0.017). On multivariable analysis, short-term outcome at 30 days was a predictor of outcome at the end of one year (RR 4.1, 95% CI 2.2–8.5) and 3 years (RR 2.1, 95% CI 1.02–4.5).

Conclusions

Short-term response to steroids is a strong predictor of long-term outcome at 1 and 3 years in active ulcerative colitis patients.

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Abbreviations

AIIMS:

All India Institute of Medical Sciences

5-ASA:

5-Aminosalicylic acid

CI:

Confidence interval

CR:

Complete response

CD:

Crohn’s disease

IBD:

Inflammatory bowel disease

IC:

Indeterminate colitis

OR:

Odds ratio

PR:

Partial response

NR:

No response

UC:

Ulcerative colitis

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Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Room No. 3111, Third Floor, Teaching Block, New Delhi, 110029, India

    Tarun Rai, Bikash Narayan Choudhury, Saurabh Kedia, Sawan Bopanna, Pratap Mouli Venigalla, Sushil Kumar Garg, Vikas Singla, Govind Makharia & Vineet Ahuja

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  1. Tarun Rai
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  2. Bikash Narayan Choudhury
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Correspondence to Vineet Ahuja.

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Rai, T., Choudhury, B.N., Kedia, S. et al. Short-Term Clinical Response to Corticosteroids Can Predict Long-Term Natural History of Ulcerative Colitis: Prospective Study Experience. Dig Dis Sci 62, 1025–1034 (2017). https://doi.org/10.1007/s10620-017-4450-0

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