PMO-7 Patient-reported outcomes on the impact of oral steroid treatment in ulcerative colitis

Introduction

Corticosteroids (CS) have formed the main stay of therapy for the treatment of acute flares of ulcerative colitis (UC). ¹ Data regarding the optimal tapering regime however is lacking. Since the introduction of CS it became apparent that their use is often associated with short and long-term side effects. ² Likewise rapid discontinuation of CS may also cause withdrawal symptoms. There remains a gap in the evidence base defining the optimal oral CS tapering regime to ensure adequate efficacy while minimising undue side effects We aimed to explore patient perspective on the general impact, benefits and side effects, associated with the use of oral CS and discover views on a short course tapering regime to manage mild to moderate flares of UC.

Method

Patient views were assessed quantitatively and qualitatively via a Crohn’s and Colitis UK led ‘Patient involvement in research’ event. The UC Steroid Questionnaire (UCSQ) poll 1 and 2 was developed based on patient and clinical input. Participants completed both UCSQ’s online. Poll 1 was by the option of multiple choice and poll 2 indicating the degree of agreement with individual statements on a 10 point Likert scale. Further debriefing interviews with the same group of patients were conducted online evaluating the content, clarity, and relevance of the items.

Results

Forty patients responded to UCSQ 1 and 49 to UCSQ 2. Approximately two-thirds (68%) of patients had experienced significant side effects from oral CS use. Sleep disruption, mood disturbance and bone thinning were of highest concern (60% vs 55% vs 55%). Overall only 53% were satisfied with the use of oral CS in managing a UC flare. Ninety-five percent of patients said they would consider participating in a trial comparing a 1 month short course to a longer 2-3 months course of oral CS to manage a mild to moderate flare, whilst 5% mentioned that they would not. The risk of suboptimal response and disease flare were amongst the main concerns elicited amongst those who were uncertain or said no.

Conclusion

Significant side effects experienced by the majority of patients following oral CS use impacted on the opinions of many towards considering a shorter CS tapering regime to manage a mild to moderate flare of UC. With better understanding of patient experiences to steroid use, we highlight the need in defining the optimal oral CS tapering regime to reduce the risk of potentially avoidable disease progression.

References

Truelove SC, Jewell DP. Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet. 1974; 1:1067–1070. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Ford AC, Bernstein CN, Khan KJ, Abreu MT, Marshall JK, Talley NJ, Moayyedi P Am J Gastroenterology. 2011 Apr; 106(4):590-9; quiz 600.