Corticosteroid therapy of flares in ulcerative colitis is less effective in patients with prior biologic therapy

Background and aims Corticosteroids are still widely used to treat flares of ulcerative colitis (UC) but steroid-refractory UC has been reported in 24-33 % of patients in historic cohorts. This study aimed to assess factors influencing efficacy of corticosteroid therapy for active UC in the biologic era.

Methods Investigator-initiated, prospective, multi-center study of the Austrian IBD study group. Patients with UC were eligible if suffering from an acute flare (Lichtiger score ≥4) and scheduled for treatment with systemic corticosteroids. Patient characteristics and Lichtiger score were assessed at baseline and after 28 days. Clinical response was defined as decrease of Lichtiger score ≥ 50 % from baseline, clinical remission as Lichtiger score ≤ 3. Statistical analyses were done using Mann-Whitney U or Chi-square tests as appropriate.

Results 98 UC patients (46 % females) were included in the analysis. Median (IQR) age was 44 (31, 57) years, 18 % of patients have been previously treated with biologics, 18 % with immunomodulators and 15 % had ongoing therapy with biologics at study inclusion. 11 % suffered from proctitis, 42 % from left-sided colitis, 47 % from pancolitis. Lichtiger Score at baseline was 11 (9, 13), 66 % had severe UC according to a Lichtiger score ≥10. The median initial steroid dose was 50 (40, 50) mg prednisolone. Therapy with corticosteroids led to a significant drop of the Lichtiger Score to 3 (1, 5) (p < 0.001) at day 28. 56 % of UC patients experienced remission, 18 % responded without remission and 26 % had no response to steroid therapy. Patients with prior, but not with ongoing, biologic therapy had higher rates of non-response to corticosteroids than biologic naïve patients (60 % vs. 19 %, p = 0.001).

Conclusion Corticosteroids induce clinical remission in more than 50 % of patients with active UC. Biologic experienced patients have higher rates of treatment failure to corticosteroids.

Publication History

Article published online:
01 September 2021