Using A Steroid-Sparing Tool In Paediatric Inflammatory Bowel Disease To Evaluate Steroid Use and Dependency.

Abstract

OBJECTIVES To evaluate the use of steroids within the paediatric inflammatory bowel disease (PIBD) population at a tertiary paediatric centre over a year; to identify cases of steroid dependency; and assess factors associated with steroid excess. METHODS The prevalent PIBD population (01/05/17-30/04/18) were reviewed. Data was collected retrospectively from patient records and entered into an online steroid assessment tool (modified for paediatrics). RESULTS 229 patients (181 Crohn's disease (CD), 31 ulcerative colitis (UC), and 17 IBD-unclassified (IBD-U)) were included. 38/229 patients (16.6%) received oral steroids; 12/38 (31.6%) receiving >3-month course. 11/38 (28.9%) received >1 steroid course (maximum 2). 37/229 (16.2%) patients had EEN, with 26/37 (11.4% total cohort) avoiding steroid use during the study period.Quiescent disease activity had a negative correlation with steroid use (11/127 (8.7%) (p < 0.01) versus 27/102 (26.5%) (p < 0.01)), and steroid dependency (3/127 (2.4%) versus 12/102 (11.8%) (p < 0.01)). UC patients were more likely to be steroid dependent (5/31 (16.1%) UC versus 10/198 (5.1%); (p = 0.02)); as were network-managed patients (8/11 (72.7%) versus 7/27 (25.9%); (p = 0.01)). 14/15 (93.3%) of steroid dependent patients had active steroid sparing strategies in place (e.g. commencement, switching or optimisation of therapies). CONCLUSIONS We have described rates of steroid use and dependency within our PIBD population. EEN served as a steroid sparing tool in 11.4% of the total cohort. Replication of this study in other paediatric centres would allow comparative analysis.