当前位置： SCI文献检索 > ALIMENTARY PHARMACOLOGY & THERAPEUTICS期刊下所有文献 > Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study.

Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study.

Abstract：

BACKGROUND:It is unclear whether adherence to prescribing standards has been achieved in inflammatory bowel disease (IBD). AIM:To determine how prescribing of 5-aminosalicylates (5-ASAs), steroids and thiopurines has changed in response to emerging evidence. METHODS:We examined trends in oral and topical therapies in 23 509 incident IBD cases (6997 with Crohn's disease and 16 512 with ulcerative colitis) using a nationally representative sample between 1990 and 2010. We created five eras according to the year of diagnosis: era 1 (1990-1993), era 2 (1994-1997), era 3 (1998-2001), era 4 (2002-2005) and era 5 (2006-2010). We calculated the proportion of patients treated with prolonged 5-ASAs (>12 months) and steroid dependency, defined as prolonged steroids (>3 months) or recurrent (restarting within 3 months) steroid exposure. We calculated the cumulative probability of receiving each medication using survival analysis. RESULTS:Half of the Crohn's disease patients were prescribed prolonged oral 5-ASAs during the study, although this decreased between era 3 and 5 from 61.8% to 56.4% (P = 0.002). Thiopurine use increased from 14.0% to 47.1% (P < 0.001) between era 1 and 5. This coincided with a decrease in steroid dependency from 36.5% to 26.8% (P < 0.001) between era 1 and 2 and era 4 and 5 respectively. In ulcerative colitis, 49% of patients were maintained on prolonged oral 5-ASAs. Despite increasing thiopurine use, repeated steroid exposure increased from 15.3% to 17.8% (P = 0.02) between era 1 and 2 and era 4 and 5 respectively. CONCLUSIONS:Prescribing in clinical practice insufficiently mirrors the evidence base. Physicians should direct management towards reducing steroid dependency and optimising 5-ASA use in patients with IBD.

journal_name

Aliment Pharmacol Ther

journal_title

Alimentary pharmacology & therapeutics

authors

Chhaya V,Saxena S,Cecil E,Subramanian V,Curcin V,Majeed A,Pollok RC

doi

10.1111/apt.13700

subject

Has Abstract

pub_date

2016-09-01 00:00:00

pages

482-94

issue

eissn

0269-2813

issn

1365-2036

journal_volume

pub_type

杂志文章

在线工具

Steroid dependency and trends in prescribing for inflammatory bowel disease - a 20-year national population-based study.