IV steroids may do more harm than good in older-onset ulcerative colitis

In patients with older-onset ulcerative colitis (UC), treatment with intravenous (IV) steroids appears to be less effective and is associated with higher risks of surgery and adverse events relative to patients with younger-onset disease, a study has found.

Researchers looked at the medical records of 467 hospitalized moderate-to-severe UC patients from 27 treatment facilities. These patients received treatment with IV steroids for the first time.

The primary outcome was clinical remission at day 30, which was assessed using a two-item patient-reported outcome scoring. The key secondary outcomes included risks of surgery and adverse events (death, infection and venous thrombosis) within 90 days. The researchers applied a modified Poisson regression model for the analyses.

Of the patients, 384 had younger-onset UC and 83 had older-onset. Clinical remission at day 30 occurred more frequently among patients in the younger-onset group than among those in the older-onset group (65.6 percent vs 51.8 percent; adjusted risk difference, −21.7 percent, 95 percent confidence interval [CI], −36.1 to −7.2; adjusted risk ratio [ARR], 0.74, 95 percent CI, 0.59–0.93).

Compared with younger-onset, older-onset UC notably had higher risks of surgery (20.5 percent vs 3.1 percent; ARR, 8.92, 95 percent CI, 4.13–19.27) and adverse events (25.3 percent vs 9.1 percent; ARR, 2.19, 95 percent CI, 1.22–3.92).

There were four deaths recorded, all involving older-onset UC. Older-onset UC also had greater risks of infection (18.1 percent vs 8.6 percent) and venous thrombosis (7.2 percent vs 0.5 percent).