Benchmarking Corticosteroid use
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Authors
Neama S.A.
Grobbelaar A.
Almukhtar F.
Jawad, N.
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2025
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Article
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Introduction: The advent of numerous biologic drugs and small molecules has significantly reduced the role of steroids in maintaining remission in inflammatory bowel disease (IBD), particularly in ulcerative colitis and Crohn's disease [1]. The British Society of Gastroenterology (BSG) recommends identifying patients who are steroid-dependent or those who relapse within three months of discontinuing steroids in order to consider escalation of therapy [2]. Additionally, the UK IBD Standards advocate for regular audits of steroid use to ensure adherence to guidelines and to identify instances of steroid misuse or excess [3]. Aims and Methods: This audit aimed to evaluate corticosteroid prescriptions for patients with inflammatory bowel disease (IBD) at Barts Health NHS Trust (Newham University Hospital, Royal London Hospital, Whipps Cross Hospital). The primary goal was to ascertain whether therapy escalation was appropriately considered in prescribing corticosteroids and benchmarked against key performance indicators for inflammatory bowel disease in the UK [1]. All corticosteroid prescriptions issued for IBD treatment were reviewed between September 2023 and September 2024. Data was collected from Electronic Medical Records to identify prior corticosteroid prescriptions within the preceding 12 months and to determine if prescribers had considered the need for therapy escalation. Result(s): A total of 368 patients received corticosteroid treatment, including 186 with ulcerative colitis and 182 with Crohn's disease. Prednisolone was the most commonly prescribed corticosteroid for ulcerative colitis (183 out of 186 cases), while budesonide was preferred for Crohn's colitis (115 out of 182 cases). Among these patients, 5 (2.6%) in the ulcerative colitis group and 6 (3.2%) in the Crohn's group met the criteria for escalation, having received 2 or more courses of oral steroids. Notably, none of the Crohn's disease patients had previously received biologic treatment. Of the patients who did not receive escalation therapy, the reasons were not clearly documented for 4 patients. Other missed escalations were attributed to factors such as referrals for the ADDapt trial, missed follow-up appointments, patient decline, or delays in escalating therapy in three instances. Importantly, none of these patients had documented hospital admissions requiring intravenous steroids or experienced surgical complications. Conclusion(s): Prescribers exhibited a judicious approach to corticosteroid use, supported by specialised clinics and multidisciplinary meetings focused on steroid-sparing strategies. However, there remains an opportunity for improvement in the appropriate use of second-line steroids, the implementation of annual audits of steroid prescribing practices, and the consideration of the need for escalation. A notable limitation of this audit was the difficulty in obtaining corticosteroid prescription data from primary care or non-specialist hospital services.
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United.Eur.Gastroenterol.J.