Analysis of the initial dose and reduction rate of corticosteroid for ulcerative colitis in clinical practice.

Background and Aim: Trends in steroid use and the effects of the initial dose, duration of use, and tapering schedule on clinical efficacy were assessed in Japanese patients with ulcerative colitis (UC) undergoing steroid treatment. Methods: We enrolled 191 cases with UC who underwent steroid treatment between 2006 and 2020. We assessed the difference in clinical remission rates in cases with different initial doses of steroid. Clinical factors for clinical remission at week 4 and discontinuation of corticosteroid within 12 weeks were also assessed. Results: Clinical remission and response at week 4 were obtained in 107 (56.0%) and 58 cases (30.4%), respectively. In hospitalized patients, male sex (odds ratio [OR], 0.373; 95% confidence interval [CI], 0.146-0.956) and younger age (OR, 0.974; 95% CI, 0.951-0.998) were associated with clinical remission at week 4. Partial Mayo score (OR, 0.643; 95% CI, 0.451-0.918) and initial steroid dose of ≥30 mg (OR, 3.278; 95% CI, 1.274-8.435) were associated with clinical remission at week 4 in outpatients. Clinical remission at week 4 (OR, 0.300; (95% CI, 0.126-0.718)) and the steroid dose reduction rate at week 4 (OR, 0.092; 95% CI, 0.036-0.234) were associated with treatment discontinuation within 12 weeks. The proportion of patients in whom corticosteroids were discontinued at week 12 was significantly higher (P = 0.006) in 2016-2020 (28/52; 53.8%) than in 2006-2010 (15/54; 27.8%). Conclusion: The steroid reduction rate at week 4 may be critical for discontinuation within 12 weeks. Withdrawal of corticosteroids has been becoming more appropriate in the last 5 years than before.

Hematologic malignancies in the Japanese patients with inflammatory bowel disease.

BACKGROUND: Although attention has been focused for over 20 years on the possible increased risk for hematologic malignancies (HM) in patients with inflammatory bowel diseases (IBD) receiving immune-modulators or anti-TNF-alpha antibodies, the association is still controversial. To understand the actual conditions of HM in the Japanese patients with IBD, the research committee for IBD supported by the Ministry of Health, Welfare and Labor of Japan (IBD-MHWL) conducted a multi-center retrospective study. METHODS: Questionnaires for the development of HM in IBD patients were sent to the 70 facilities participating with IBD-MHWL in the first survey, followed by the second survey using a more detailed questionnaire, sent to the 27 members with HM patients. RESULTS: Out of a total of 36,939 IBD patients in 70 facilities, 28 cases of HM related with IBD [12 of 10,500 UC patients (0.11 %), 16 of 6,310 CD patients (0.25 %)] were analyzed. The numbers of UC patients who developed HM were 2 (0.15 %) from the group receiving and 10 (0.13 %) from the group non-receiving thiopurine, without significant differences. The numbers of CD patients who developed HM were 4 (0.39 %) from the group receiving and 12 (0.21 %) from the group non-receiving thiopurine, without significant differences. The odds ratios of developing HM by thiopurine were 1.37 (95 % CI 0.30-6.24) in UC patients and 1.86 (95 % CI 0.60-5.78) in CD patients. CONCLUSIONS: Our results suggested that thiopurine therapy may not be a risk factor for HM in Japanese patients with IBD. Further accumulation of cases and prospective studies are necessary to conclude this important issue.

The absence of large ulcer predicts latent cytomegalovirus infection in ulcerative colitis with positive mucosal viral assay.

OBJECTIVE: Although many studies have shown that cytomegalovirus (CMV) infection is an exacerbating factor in patients with ulcerative colitis (UC), there is no valid method to distinguish CMV infection requiring therapy from that disappearing without therapy. The aim of this study was to describe whether or not the endoscopic feature of a large ulcer predicts the necessity of antiviral therapy against CMV infection in active UC patients with positive mucosal viral assay. METHODS: Active UC patients in whom CMV infection was detected by mucosal polymerase chain reaction (PCR) assay were enrolled in this prospective observational clinical study. Patients with a large ulcer (ulcerated group) were treated with antiviral and UC therapy. Patients without a large ulcer (non-ulcerated group) were treated with only UC therapy. We prospectively evaluated the clinical and endoscopic findings in all of the patients 2 months after starting this protocol, and observed their outcomes during one year. RESULTS: In the ulcerated group (n=10), 3 patients still had active disease at 2 months and underwent colectomy. Although the other 7 patients achieved remission at 2 months, 4 of the 7 patients had a flare-up, and the remaining 3 patients maintained remission. All of the patients in the non-ulcerated group (n=10) attained remission without antiviral therapy at 2 months, and maintained remission. CONCLUSION: In active UC patients with positive CMV DNA by mucosal PCR assay, the absence of a large ulcer suggests latent CMV infection, and requires no antiviral therapy.