Abstract
Background: Despite data from the Treat Registry, corticosteroids and opiates are still commonly used in inflammatory bowel disease (IBD). During an IBD flare, corticosteroids are a common first line option and opiates are often prescribed for associated abdominal pain. Longer term use of both agents increases the risk of complications, adverse IBD outcomes and can impair quality of life. We sought to understand the size of the "problem" by examining the current real-world prescribing practices for people with IBD across Australia and New Zealand.
Methods: Crohn’s Colitis Care (CCCare) is a cloud-based electronic medical record used in Australasia. Data feed into a deidentified clinical quality registry (CQR), which was interrogated in September 2024. People with IBD under active care (encounter within 14 months) were included.
Results: Of 7506 eligible people, 73.1% resided in Australia (n=5487) and 26.9% (n=2019) in New Zealand. There was an even gender distribution with 49.0% (n=3679) male, 48.0% (n=3606) female, and 2.9% (n=221) with gender not documented. The median age was 42 years (IQR 31 – 56) and median disease duration was 10.7 years (IQR 5.1 – 19.2). In the preceding year, 8.6% (n=645) of the cohort were prescribed a course of oral steroids, of whom 61.1% (n=394) were also prescribed an advanced therapy (biologic or novel small molecule). The most common reasons for discontinuing steroids were "course completed" (26.4%, n=112), "inadequate efficacy" (20.75%, n=88), and "rationalisation and/or deep remission" (12.0%, n=51). There was no difference in the rate of steroid use between IBD subtypes (7.9% in Crohn’s disease (CD) vs 9.4% in Ulcerative Colitis (UC) vs 10.4% in IBD-Unclassified (IBDU), p = 0.06). Opiates were prescribed in 7.6% (n=567) of the cohort. However, opiates were only for an IBD indication in 184 people (2.5% of the cohort), with others receiving opiates for nonIBD indications. People with CD were more likely to have been prescribed an opiate than those with IBDU and UC (p < 0.001).
Conclusion: These are the first data on corticosteroid and opiate use in IBD across Australia and New Zealand. Steroid use in ambulatory care is low and most use appears to be as a bridge to maintaining disease control with other therapy. Globally, reported rates of corticosteroid use have ranged from 13-57%, however much of the data has been explored over longer time periods in comparison to our study. Opiate use within our Australian and New Zealand cohort is comparable to international IBD cohorts. While steroids are predominately used for IBD, opiate use appears to be related to other co-morbidities. These comorbidities are of interest to examine to identify further opportunities to optimise care.