Corticosteroid Use in Childhood-Onset Inflammatory Bowel Disease: A Nationwide Cohort Study (2006-2022)

BACKGROUND: We aimed to determine corticosteroid (CS) use in paediatric inflammatory bowel disease (PIBD, < 18 years), which remains common despite recommendations for limited use and the emergence of steroid-sparing therapies.

METHODS: We conducted a study of all children in Sweden diagnosed with CD (n = 2460) or UC (n = 2470) in 2006-2022. Nationwide health registers provided annual individual-level data on CS use, classified as any use and excess use (i.e., ≥ 2 courses or ≥ 3 months of use per year).

RESULTS: The mean age at diagnosis was 13.7 (SD = 3.4) for CD and 13.9 (SD = 3.8) years for UC. In CD, the proportion of patients with any annual CS use decreased from 42.9% (2006) to 27.6% (2022; p < 0.001), particularly for excess CS use (decreasing from 33.7% to 19.1%; p < 0.001). Rates in UC remained largely unchanged, with any CS use at 41.0% in 2006 and 43.6% in 2022 (p = 0.43), while excess use was 32.4% in 2006 and 36.2% in 2022 (p = 0.21). Although any CS use was most common during the first year after diagnosis (CD: 63.8%, UC: 70.6%), annual rates stabilised only during the fourth (CD) and fifth (UC) years of diagnosis. Older age at diagnosis and prior IBD-related hospitalisation were risk factors for excess CS use in both CD and UC.

CONCLUSIONS: The use of CS in PIBD remains high, with annual rates showing no reduction in UC over the past more than 15 years, while a marked decline is observed in CD. Our data should inform strategies to reduce excess CS use in children.