Patterns Between Multi-Year Steroid Use in Patients with Inflammatory Bowel Disease and Quality of Life, Disease Severity, and Healthcare Utilization

Abstract

Introduction: Quality improvement measures for Inflammatory Bowel Disease (IBD) providers emphasize limiting steroid use, as prolonged use is associated with complications including infection, osteoporosis. The aim of this study was to characterize patterns of steroid use in IBD patients over multi-year time periods and the relationship with quality of life (QOL), healthcare use, and disease severity. Methods: Patients followed in a prospective IBD natural history registry for >4 years from 2009 to 2015 were grouped based on low (<1 year), medium (2 to 3 years), and high steroid use (>4 years). Measures of disease activity, including Harvey-Bradshaw Index (HBI), Ulcerative Colitis Activity Index (UCAI); QOL using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) (with scores < 50 indicating poor QOL); healthcare use, including total charges, ER and clinic visits, hospital admissions; narcotic use; antidepressant use were organized. Steroid usage groups were compared using ANOVA analysis for parametric measures and Kruskal-Wallis H for non-parametric ones. Results: 1,457 patients were followed (47.0+15.5 years old, 52.4% female, 56.6% with Crohn's Disease, 34.8% with Ulcerative Colitis) and divided into low (63.7%, n=928), medium (24.3%, n= 354), and high steroid use (12.0%, n=175) without a difference in age (p=0.44), disease type (p=0.094), mean BMI (p=0.25). Mean SIBDQ scores varied amongst groups (54.4+10.8 for low, 50.4+11.3 for medium, 48.6+10.9 for high use, p0.001). The groups varied in narcotic and anti-depressant use, chronic abdominal ratings, as well as feeling discouraged, unable to conduct regular activities (all p < 0.001). Steroid use correlated with Clostridium difficile infection and vancomycin exposure (all p < 0.001). Disease activity indices (UCAI, HBI) and healthcare utilization, including total charges, ER and clinic visits, and hospital admissions were found different amongst the groups (all p < 0.001). Conclusion: Most IBD patients require low steroid use, but a subset requires prolonged use given more severe and refractory disease. Quality measures for steroid use need to account for the difference amongst patients when assessing providers. Steroid use also correlates with potentially modifiable measures, such as worse QOL measures and narcotic and anti-depressant use. Through multi-faceted care that focuses on pain control and psychiatric care, IBD providers may be able to improve steroid use amongst their patients.