A Retrospective Comparison of Health Care Outcomes in Crohnʼs Disease Patients with and without Prolonged Steroid Monotherapy

Abstract

Purpose: Short-term steroid use is effective in improving Crohn's disease (CD) symptoms; however, lack of effectiveness and increased health risks make long term steroid use undesirable.1 Methods: To assess effects of prolonged steroid monotherapy on indicators of flares (hospitalization/surgery/emergency dept [ED]) and occurrence of osteoporosis in patients with CD, a retrospective analysis of a Thomson MarketScan® claims database (Q1 2000-Q4 2009) was performed. MarketScan included combined claims of approximately 100 employers and covered >60 million lives across all census regions. CD patients >18 years old with ≥2 CD diagnoses (ICD-9-CM: 555.xx) receiving oral or intravenous steroids without concurrent immunomodulators or biologics were grouped into 2 mutually exclusive cohorts: prolonged steroid monotherapy (≥3 months) or no prolonged steroid monotherapy (<3 months). Beginning at initiation of steroid treatment (index date), 1-year outcomes, which included CD-related resource utilization and complications related to steroid use, were assessed. Study outcomes were compared between cohorts using multivariate logistic regressions adjusting for demographics, comorbidities, prior treatments, and baseline health care resource utilization. Results: 64.6% of the 11,124 patients included in the study had prolonged use of steroids as monotherapy. During the 1 year evaluation period, patients with CD with prolonged steroid monotherapy had higher risks of experiencing CDrelated inpatient visits and other study events compared with those with no prolonged steroid monotherapy (Table).Table: No Caption available.Conclusion: Based on this claims data analysis, the majority of patients with CD received prolonged steroid monotherapy, which was associated with greater risks of CD-related hospitalization, ED visits, and osteoporosis compared with short-term steroid monotherapy.