Real-World Utilization Patterns of Corticosteroids in Ulcerative Colitis: Prevalence of Excessive Use in Routine Clinical Practice
Author(s)
Anuja Bhardwaj, MSc1, Devian Parra-Padilla, MSc2, Anoushka Pathak, MSc1, Tushar Srivastava, MSc2, Raju Gautam, PhD2.
1ConnectHEOR, Delhi, India, 2ConnectHEOR, London, United Kingdom.
1ConnectHEOR, Delhi, India, 2ConnectHEOR, London, United Kingdom.
OBJECTIVES: In ulcerative colitis (UC), corticosteroids (CS) remain a key therapeutic option for symptom control. However, prolonged and repeated use of CS contradicts treatment guidelines. This study explores real-world patterns of CS use before initiation of advanced therapies (ATs) among patients with UC with a focus on identifying excessive CS exposure.
METHODS: A targeted literature review was conducted in PubMed database (January-2014-January-2025) to identify studies reporting real-world patterns of excessive use of CS. The key outcomes included CS use patterns in initial and subsequent treatment lines, use as monotherapy and in combination, recurrence, chronic use, and duration of long-term exposure.
RESULTS: Of 222 records screened, 10 studies meeting criteria for excessive CS use were included. These studies were from the US (n=5), Japan (n=3), China (n=1) and multi-countries (n=1). Seven studies reported CS monotherapy as the second most used initial treatment in 10-37% of patients. One study reported CS use in combination with 5-aminosalicylic acid (5-ASA) as the second most used initial regimen. Eight studies showed that in subsequent lines of treatment, patients were treated with CS either as monotherapy or in combination therapies with 5-ASA or immunomodulators or both. Three studies reported that CS was introduced as an add-on therapy in 47-76% of patients. One study described that the most common next agent after switch was CS (in more than 50% of patients). Evidence showed that most patients (80-92%) received more than CS course, with an average of 4-6 courses before AT initiation (n=5). The prolonged/chronic use of CS (varying definitions across studies) ranged from 11-49% (n=10). The reported duration of long-term CS exposure ranged from 209-453 days (n=3).
CONCLUSIONS: The clinical guidelines in UC recommend early, sustained disease control and specifically early access to ATs, which serve as steroid-sparing treatments. Despite this, excessive CS use remains common, highlighting persistent treatment inertia.
METHODS: A targeted literature review was conducted in PubMed database (January-2014-January-2025) to identify studies reporting real-world patterns of excessive use of CS. The key outcomes included CS use patterns in initial and subsequent treatment lines, use as monotherapy and in combination, recurrence, chronic use, and duration of long-term exposure.
RESULTS: Of 222 records screened, 10 studies meeting criteria for excessive CS use were included. These studies were from the US (n=5), Japan (n=3), China (n=1) and multi-countries (n=1). Seven studies reported CS monotherapy as the second most used initial treatment in 10-37% of patients. One study reported CS use in combination with 5-aminosalicylic acid (5-ASA) as the second most used initial regimen. Eight studies showed that in subsequent lines of treatment, patients were treated with CS either as monotherapy or in combination therapies with 5-ASA or immunomodulators or both. Three studies reported that CS was introduced as an add-on therapy in 47-76% of patients. One study described that the most common next agent after switch was CS (in more than 50% of patients). Evidence showed that most patients (80-92%) received more than CS course, with an average of 4-6 courses before AT initiation (n=5). The prolonged/chronic use of CS (varying definitions across studies) ranged from 11-49% (n=10). The reported duration of long-term CS exposure ranged from 209-453 days (n=3).
CONCLUSIONS: The clinical guidelines in UC recommend early, sustained disease control and specifically early access to ATs, which serve as steroid-sparing treatments. Despite this, excessive CS use remains common, highlighting persistent treatment inertia.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA83
Topic
Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
Gastrointestinal Disorders