PMO-5 Steroids and tapering regimes in Inflammatory Bowel Disease – What do we prescribe?

• Published in: Gut Vol. 70; no. Suppl 4; pp. A77 - A78
• Main Authors: Salem, Joseph, Pollok, Richard
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 07.11.2021; BMJ Publishing Group LTD
• Subjects: Budesonide; Crohn's disease; Gastroenterology; Inflammatory bowel disease; Inflammatory bowel diseases; Intestine; Patients; Prednisolone; Remission; Steroid hormones; Steroids; Ulcerative colitis
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2021-BSG.144

IntroductionSteroids have been an established treatment in flares of inflammatory bowel disease (IBD) for the past 50 years. Whilst evidence exists to guide the initial dose of these drugs, data regarding the optimal length and tapering regime is lacking and consequently anecdotal reports suggests prescribing practice varies substantially. Steroids have a wide range of side-effects according to the dose and duration of therapy. We aimed to help characterise steroid prescribing practice in the UK for the management of inflammatory bowel disease.MethodsA survey was created using Google Forms® and circulated with the support of the British Society of Gastroenterology using the members email distribution over a 2 week period. All questions were mandatory and focused around clinical scenarios of mild-to-moderate disease flares in Ulcerative Colitis (UC) and Crohn’s Disease (CD).Results128 healthcare professionals completed the survey of which 123 were able to prescribe steroids. 80% of respondents were consultants (n=98) followed by 10% specialist registrar (n=12) and 4% IBD CNS (n=5).92% of prescribers (n=113) would treat a UC flare with 40mg Prednisolone. 65% (n=80) would give full treatment dose for 7 days followed by 23% (n=28) giving full treatment for 14 days. 86% (n=106) would prescribe a tapering regime of 5mg every week with 7% (n=8) tapering 5mg every 5 days. 98% of respondents (n=121) would not prescribe steroids to maintain remission of UC.90% of prescribers (n=111) would give the same dose and taper for a Crohn’s patient with a similar flare. For those prescribing differently in a CD flare, 67% (n=8) would start at Prednisolone 40mg followed by 17% (n=2) prescribing a dose of 0.75-1mg/kg and 17% (n=2) a differing preparation. 50% (n=6) would prescribe full treatment dose for 7 days followed by 25% (n=3) prescribing full treatment for 14 days and 17% (n=2) prescribing full treatment for greater than 14 days. 50% (n=6) would prescribe a tapering regime of 5mg every week with 33% (n=4) tapering 5mg every 5 days.72% prescribed 2nd generation synthetic steroids (budesonide preparations/beclomethasone) for UC patients (n=88) versus 76% in CD patients. 54% (n=66) would use these preparations before conventional steroids in mild-moderate flares of UC versus 79% in mild-moderate flares of CD.ConclusionThe survey indicates some variation in steroid prescribing for IBD patients. The majority prescribe an 8 week regime with a starting dose of 40mg daily for 7 days and a taper of 5mg every week thereafter. 2nd generation steroids were more frequently prescribed in CD than in UC with the majority agreeing that these preparations should be offered before conventional steroids. Whilst steroid prescribing is not underscored by a firm evidence base it is reasonably consistent. Further research is needed to define the optimal tapering regime.