Similar results for different corticosteroid tapering protocols in UC

Different prednisolone tapering algorithms did not affect the short-term or long-term effectiveness of infliximab in participants with ulcerative colitis (UC). However, subgroup analysis showed participants with acute severe UC may benefit from standard tapering compared with fast tapering or direct discontinuation of corticosteroids.

Corticosteroids are administered in more than 50% of the patients with UC in the first 5 years after diagnosis [1]. In patients with acute severe UC, corticosteroids are often administered in combination with TNF inhibitors. However, data is limited on the role of corticosteroid tapering in this population. The current, retrospective, single-centre study investigated the impact of prednisolone tapering algorithms on the short-term and long-term effectiveness of infliximab in patients with UC [2]. Participants were categorised according to the following tapering protocol: standard (≤5 mg/week; n=42), fast (>5 mg/week; n=25), direct discontinuation (n=10), or no prednisolone administered (n=71). Corticosteroid-free clinical remission was the clinical endpoint of the study (defined as a partial Mayo score ≤1). Ms Pernille Ovesen (Herlev University Hospital, Denmark) presented the short-term (week 14) and long-term (week 52) results.

At week 14, no significant differences in corticosteroid-free clinical remission rates were reported for participants who underwent standard corticosteroid tapering (57.1%), fast tapering (36.0%), direct discontinuation (40.0%) or those who did not receive prednisolone (40.8%). However, the C-reactive protein levels <5 mg/L significantly favoured the standard tapering arm (100%) over the fast-tapering arm (77.8%; P=0.03) and the direct discontinuation arm (60.0%; P=0.03). The results after week 52 did not display a significant effect of tapering protocols on clinical remission or response rates in the overall study population.

A subgroup analysis, including 33 participants with acute severe UC, did show a significant benefit of the standard tapering protocol over fast tapering with regard to corticosteroid-free clinical remission rates (66.7% vs 23.5%; P<0.05) at week 14.

“The data indicates that a longer corticosteroid exposure might improve infliximab responses in patients with a higher disease burden,” concluded Ms Ovesen.

1. Burisch J, et al. J Crohns Colitis. 2019;13(2):198­208.
2. Ovesen PD, et al. The influence of different prednisolone tapering algorithms on the effectiveness of infliximab in patients with ulcerative colitis – a real-world cohort study. OP06, ECCO 2022, 16–19 February.

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Posted on 12 April 20228 April 2024