Patterns and Predictors of Steroid Use in a Real-World Inflammatory Bowel Disease Cohort

Rodger Wu; Consuelo Rivas; Wai Kin Su; Renée Deschenes; William Wilson; Joseph L Pipicella; Susan J Connor; Jane M Andrews; Crohn's Colitis Cure (CCCure) Data Insights Program

doi:10.1002/jgh3.70308

Patterns and Predictors of Steroid Use in a Real-World Inflammatory Bowel Disease Cohort

JGH Open. 2025 Dec 8;9(12):e70308. doi: 10.1002/jgh3.70308. eCollection 2025 Dec.

Authors

Rodger Wu^{1

2

3

4}, Consuelo Rivas¹, Wai Kin Su^{1

2

3}, Renée Deschenes², William Wilson^{2

5

6}, Joseph L Pipicella^{1

2

3}, Susan J Connor^{1

2

3

4}, Jane M Andrews^{2

7

8}; Crohn's Colitis Cure (CCCure) Data Insights Program

Collaborators

Crohn's Colitis Cure (CCCure) Data Insights Program:
Yoon-Kyo An, Jakob Begun, Ray Boyapati, Shoma Dutt, Richard B Gearry, Simon Ghaly, Craig Haifer, Ian C Lawrance, Kate Lynch, Gregory Moore, Graham Radford-Smith, Asif Shahzad, Michael Schultz, Heidi Su, Watson Ng, Christine Verdon, Gareth Walker, Gabrielle Wark

Affiliations

¹ Department of Gastroenterology and Hepatology Liverpool Hospital Sydney New South Wales Australia.
² Crohn's Colitis Cure (CCCure) Sydney New South Wales Australia.
³ Ingham Institute for Applied Medical Research Liverpool New South Wales Australia.
⁴ South West Sydney Clinical Campuses, UNSW Medicine & Health UNSW Sydney New South Wales Australia.
⁵ Department of Anaesthesia Lyell McEwin Hospital Adelaide South Australia Australia.
⁶ SA Health Chief Medical Information Officer Adelaide South Australia Australia.
⁷ IBD Service Royal Adelaide Hospital Adelaide South Australia Australia.
⁸ Faculty of Health and Medical Sciences University of Adelaide Adelaide South Australia Australia.

Abstract

Background: Patterns of steroid use in inflammatory bowel disease remain poorly characterized in real-world settings. Steroid exposure is associated with adverse effects and often indicates suboptimally controlled disease. Therefore, patterns and predictors of steroid use in a large inflammatory bowel disease cohort were examined.

Methods: Steroid exposure over a 3-year window was explored. Use was classified by duration-short (1-28 days), moderate (29-56 days), prolonged (> 56 days), and recency (within last year, prior years or no exposure). Associations with demographic and disease-related factors were assessed using multivariable logistic regression.

Results: Among 5436 people (median age 42 years, IQR 32-56), 18.3% (n = 994) were steroid exposed. 57.6% had Crohn's disease and 50.2% were female. Crohn's disease was associated with lower odds of both prolonged and recent exposure compared to ulcerative colitis (AOR 0.72, p = 0.001 and AOR 0.78, p = 0.037, respectively). Females had a greater likelihood of both prolonged and recent exposure (AOR 1.22, p = 0.048 and AOR 1.23, p = 0.041, respectively). Young adults (20-29 years) had higher odds of prolonged and recent use than those > 70 years (AOR 6.59 and 9.12, respectively, p < 0.001). Combination immunomodulator and advanced therapy use was associated with a higher likelihood of both prolonged and recent use compared to 5-aminosalicylic acid therapy alone (AOR 4.01, p = 0.002 and AOR 4.54, p < 0.001). Age at diagnosis had a modest effect size (AOR 1.03, p < 0.001).

Conclusion: Steroid use was modest, with over 80% unexposed over 3 years. Proactive optimization of therapy, particularly in younger individuals and those with ulcerative colitis, may further reduce steroid exposure.

Keywords: corticosteroid stewardship; real‐world data; risk stratification; steroid exposure patterns; treatment escalation.