P054 Use of corticosteroids at time of diagnosis in ulcerative colitis is common and this practice remains unchanged over time

BACKGROUND: Corticosteroids (CS) have been the mainstay for treatment of moderate to severe ulcerative colitis for more than 60 years. Side effects and complications are increasingly recognized, and the aim in clinical practice is generally to minimize its use. The aims of this study were to describe whether the practice of administering CS as standard tapered courses at the time of diagnosis had changed during a 6-year period (2012–2017), and also to investigate if patients selected for this regimen overall had more severe and extensive disease. METHODS: In total, 203 patients, aged 16 years and above, were consecutively included at time of UC diagnosis in a single center cross sectional study conducted at Stavanger University Hospital, Norway, from 2012 to 2017. Demographic data, medication, CRP, albumin, fecal calprotectin and Partial Mayo Score (PMS) were recorded. In addition, disease distribution (Montreal Classification) and severity (Mayo Endoscopic Score, MES-UC) were assessed at index colonoscopy. A time trend analysis for yearly CS administration was performed using logistic regression, other variables were compared pairwise. RESULTS: Overall median (range) age was 34 (16–76) years, and 59% were males. Median CRP concentration was 5.5 mg/L (1–184), albumin 39.5 g/L (10.3–49.6) and fecal calprotectin 695 mg/kg (17–5,466), whereas median PMS was 5 (0–9). Proctitis (E1) was diagnosed in 27.7% of the patients, whereas 28.2% had left sided colitis (E2) and 44.6 % had pancolitis (E3). All patients received 5-ASA treatment (12.5% topical, 35% oral, and 52.5% combined). Antibiotic treatment was prescribed in 13.3 % of the patients, whereas 6.4% received a biological agent and 2% conventional immunosuppressive drugs. CS treatment rate at time of diagnosis was 41.9%, with no significant year-to-year variation, ranging from 30% to 50%, in the selected time period, P = 0.32. Patients treated with CS had higher median CRP (22 vs 2.9 mg/L, P < 0.001), fecal calprotectin (1,052 vs 575 mg/kg, P = 0.02) and PMS (6.5 vs 4, P < 0.001), and a lower albumin (36.0 vs 41.8 g/L, P < 0.001) than patients not receiving CS. CS-treated patients were also more likely to have pancolitis (E3) than left sided colitis (E2), P = 0.001, and more severe disease activity (MES-UC score 3 vs 2), P < 0.001. CONCLUSION(S): The practice of administering CS courses at time of diagnosis in UC remained high, with no significantly yearly variation in treatment rate during the selected 6-year period. Commencing CS courses was associated with higher disease activity and more extensive disease. This indicates that CS treatment still has an essential role in the treatment of severe UC disease.