Self-medication with oral corticosteroids reported by patients with ulcerative colitis

Abstract Background There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn’s disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent. Methods UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients’ treatment, disease progression and overall health care utilization prior to initiating biologic agents. Results Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased. Conclusions Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.

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P486 Intravenous corticosteroids in moderate active ulcerative colitis not responding to oral corticosteroids

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60507-3 ◽

2013 ◽

Vol 7 ◽

pp. S204-S205

Author(s):

J. Llaó ◽

J.E. Naves ◽

A. Ruiz-Cerulla ◽

L. Marín ◽

M. Mañosa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Active Ulcerative Colitis ◽

Oral Corticosteroids

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P095 COMPARING ORAL CORTICOSTEROIDS ≥30MG/DAY AMONG ADULT AND PEDIATRIC PATIENTS WITH NEWLY DIAGNOSED ULCERATIVE COLITIS

Gastroenterology ◽

10.1053/j.gastro.2019.01.158 ◽

2019 ◽

Vol 156 (3) ◽

pp. S65-S66

Author(s):

Theresa Hunter ◽

April Naegeli ◽

Amy Larkin ◽

Wendy Komocsar ◽

Krista Schroeder ◽

...

Keyword(s):

Ulcerative Colitis ◽

Pediatric Patients ◽

Newly Diagnosed ◽

Oral Corticosteroids

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PWE-027 Self-medication with oral corticosteroids in amongst patients with inflammatory bowel disease

10.1136/gutjnl-2018-bsgabstracts.159 ◽

2018 ◽

Author(s):

Marie Jasim ◽

Richard Pollok

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Self Medication ◽

Oral Corticosteroids ◽

Inflammatory Bowel

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A rare complication of acute severe ulcerative colitis

Acta Gastro Enterologica Belgica ◽

10.51821/84.2.022 ◽

2021 ◽

Vol 84 (3) ◽

pp. 525-526

Author(s):

E Dias ◽

R Coelho ◽

A.C. Nunes ◽

P Andrade ◽

L Malheiro ◽

...

Keyword(s):

Ulcerative Colitis ◽

Rare Complication ◽

Wall Thickening ◽

Extensive Disease ◽

Spontaneous Bleeding ◽

Reactive Protein ◽

Free Air ◽

Oral Corticosteroids ◽

Tomography Scan ◽

New Onset

A 21-year-old female with ulcerative colitis presented with abdominal pain and bloody diarrhea. Laboratory studies revealed markedly elevated C-reactive protein and thrombocytosis. Flexible sigmoidoscopy revealed severe endoscopic activity with ulceration and spontaneous bleeding along rectum and sigmoid colon. Ulcerative colitis had been diagnosed 3 years before, presenting as severe and extensive disease (pancolitis). She had previously failed therapy with infliximab and vedolizumab and had recently started induction therapy with golimumab. She responded well to intravenous corticosteroids but, when switched to oral corticosteroids, there was symptomatic recurrence. Intravenous corticosteroids were re-started and she was evaluated for surgery. At this time, she developed new-onset tachycardia. Electrocardiogram revealed sinus tachycardia with heart rate of approximately 120 bpm. Because tachycardia could result from worsening colitis with potential serious complications, abdominal computerized tomography scan was performed and demonstrated mild lumen dilation and wall thickening consistent with acute colitis without evidence of pneumoperitoneum or toxic megacolon. Surprisingly, thoracic planes revealed the presence of free air dissecting mediastinal space (Figure 1). What is your diagnosis?

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N01 Factors related to self-medication with corticosteroids, aminosalicylates or analgesics and reasons given by patients with ulcerative colitis from Spain

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.985 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S657-S657

Author(s):

M Cañas ◽

F Mesonero ◽

I Rodriguez-Lago ◽

C Savini ◽

R Saldaña ◽

...

Keyword(s):

Ulcerative Colitis ◽

Emergency Room ◽

Working Group ◽

Associated Factors ◽

Self Care ◽

Female Gender ◽

Cross Sectional Survey ◽

Self Medication ◽

Cross Sectional ◽

The Past

Abstract Background Self-medication, when agreed with the treating physician, is an essential component of self-care. We describe the associated factors and the reasons related to the practice of self-medication with steroids, aminosalcylates (AS) or analgesics in patients with ulcerative colitis (UC) in Spain. Methods Information was anonymoulsy provided by patients through a web-based cross-sectional survey developed by 3 inflammatory bowel disease (IBD) experts from the Spanish working group on IBD (GETECCU), one nurse from the Spanish nursing working group on IBD (GETEII) and two patients from the Spanish confederation of associations of patients with IBD (ACCU). Participants voluntarily answered to the survey based on their own experiences from February to April 2019. Reasons for self-medication are described as frequencies and associated factors through logistic regression models. Results A total of 546 patients (61% women, mean age 40 years old) responded. Of these, 36 (7%) patients self-medicated with corticosteroids, and was associated with higher number of UC self-reported flares during the past year [OR 7 (95% CI: 1–32), p < 0.001] and follow-up by a general gastroenterologist instead of in an IBD unit [OR 0.08 (0.01–0.5), p = 0.007]. Self-medication with AS was reported by 90 patients (16%) [oral 20 (22%) and topic 70 (78%)], and was associated with treatment with topical AS [OR 3 (95% CI: 2–4), p < 0.001]. Finally, 320 patients (59%) self-medicated with analgesics and this was associated with female gender [OR 2 (95% CI: 1–3), p < 0.001], need of intravenous (IV) biological therapy [OR 3 (95% CI: 2–5) p < 0.001] and emergency room visits within the past year [OR 3 (95% CI: 2–4), p < 0.001]. The main reasons for self-medication were ‘need for quick relief of symptoms’, ‘fear of worsening’ and, for AS, ‘agreed with the doctor’ (Table 1). Conclusion Self-medication in UC is not a common practice, but most of the times it is not agreed with the treating physician. Self-medication with analgesics was more frequent, probably reflecting a need of self-care. Female sex, number of flares, IV treatment, and need of emergency room care were factors associated to self-medication. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

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Tracheobronchitis in ulcerative colitis: a case report of therapeutic response with infliximab and review of the literature

BMC Gastroenterology ◽

10.1186/s12876-019-1091-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Lisa Horgan ◽

Siobhain Mulrennan ◽

Lloyd D’Orsogna ◽

Andrew McLean-Tooke

Keyword(s):

Ulcerative Colitis ◽

Case Report ◽

Inhaled Corticosteroids ◽

Rare Complication ◽

High Dose ◽

Clinical Effects ◽

Case Presentation ◽

First Case ◽

Oral Corticosteroids ◽

Symptomatic Remission

Abstract Background The extra-intestinal manifestation of tracheobronchitis is a rare complication of ulcerative colitis (UC). Here, we present a case of UC-related tracheobronchitis wherein the positive clinical effects of infliximab are demonstrated. Case presentation We report the case of a 39-year old woman who presented with a chronic productive cough on a distant background of surgically managed ulcerative colitis (UC). Our patient failed to achieve a satisfactory clinical improvement despite treatment with high dose inhaled corticosteroids, oral corticosteroids and azathioprine. Infliximab therapy was commenced and was demonstrated to achieve macroscopic and symptomatic remission of disease. Conclusions We present the first case report documenting the benefits of infliximab in UC-related tracheobronchitis.

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P371 Self-medication with analgesics in ulcerative colitis: Results of a patient survey

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.500 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S349-S350

Author(s):

I Rodríguez-Lago ◽

F Mesonero Gismeno ◽

M Cañas ◽

C Savini ◽

R Saldaña ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Emergency Room ◽

Disease Activity ◽

Bowel Disease ◽

Working Group ◽

Online Survey ◽

Hospital Admissions ◽

Self Medication ◽

Inflammatory Bowel

Abstract Background Ulcerative colitis (UC) is a debilitating chronic condition that affects the large intestine and courses with episodes of flare and remission, being steroid-free remission the main treatment goal. Our aim was to assess the prevalence of self-medication with analgesics, and its associated factors in a Spanish cohort of UC patients. Methods An anonymous cross-sectional survey was developed by 3 IBD experts from the Spanish working group on Crohn’s disease (CD) and Ulcerative Colitis (GETECCU), one nurse of the Spanish nursing working group on inflammatory bowel disease (GETEII) and two patients from the Spanish confederation of associations of patients with CD and UC (ACCU). A link to the online survey was distributed to the ACCU affiliates and to other adult patients with UC through 50 inflammatory bowel disease (IBD) units from Spain. Participants voluntarily answered to the survey based on their own experiences during the last year. Results We collected data from 546 patients, 61% women, mean age 40 years old. Of these, 51% patients were followed-up by IBD specialists and 47% by a general gastroenterologist. Patients’ self-reported disease activity during the last year was: 125 (23%) inactive, 188 (34%) mild, 170 (31%) moderate and 63 (12%) severe. Visits to the emergency room (24%), urgent telephone calls (43%) and hospital admissions (10%) were reported by patients during the last year. A total of 320 (59%) patients declared to have self-medicated with analgesics during the past year, mostly with paracetamol [n = 247 (45%)] and metamizole [118 (22%)], followed by ibuprofen [26 (5%)] and codeine [23 (4%)]. The frequency of self-medication was higher in those patients who declared having a moderate (57%) to severe (65%) disease activity, compared with those who felt their disease was mild (45%) or inactive (39%), (p < 0.001). In addition, patients who needed urgent telephone assistance showed a higher frequency of self-medication (n = 139, 59%) [OR 2 (95% CI:1–3), p < 0.001]. Multivariate analysis revealed that self-medication with analgesics was associated to female gender [OR 2 (95% CI: 1–3), p < 0.001], intravenous (IV) biological therapy [OR 3 (95% CI: 2–5), p < 0.001] and visits to the emergency room [OR 3 (95% CI: 2–4), p < 0.001]. Conclusion Self-medication with analgesics is a common practice in patients with UC from Spain. Factors like being a woman, treatment with IV biological drugs, needing urgent telephone assistance and attending to the emergency room, were associated with self-medication with analgesics. This project was endorsed by GETECCU, GETEII, ACCU and funded by MSD Spain.

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