Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3005-3015
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3005
Corticosteroid therapy in ulcerative colitis: Clinical response and predictors
Jin Li, Fan Wang, Hong-Jie Zhang, Jian-Qiu Sheng, Wen-Feng Yan, Min-Xing Ma, Ru-Ying Fan, Fang Gu, Chuan-Feng Li, Da-Fan Chen, Ping Zheng, Yu-Pei Gu, Qian Cao, Hong Yang, Jia-Ming Qian, Pin-Jin Hu, Bing Xia
Jin Li, Fan Wang, Wen-Feng Yan, Min-Xing Ma, Bing Xia, Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Jin Li, Fan Wang, Wen-Feng Yan, Min-Xing Ma, Bing Xia, Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan 430071, Hubei Province, China
Hong-Jie Zhang, Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Jian-Qiu Sheng, Ru-Ying Fan, Department of Gastroenterology, Military General Hospital of Beijing PLA, Beijing 100700, China
Fang Gu, Chuan-Feng Li, Department of Gastroenterology, Third Affiliated Hospital of Peking University, Beijing 100191, China
Da-Fan Chen, Ping Zheng, Department of Gastroenterology, First Affiliated Hospital of Shanghai Jiaotong University, Shanghai 201620, China
Yu-Pei Gu, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, China
Qian Cao, Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Hong Yang, Jia-Ming Qian, Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
Pin-Jin Hu, Department of Gastroenterology, Sixed Affiliated Hospital of Zhongshan University, Guangzhou 528000, Guangdong Province, China
Author contributions: Li J and Wang F contributed equally to this paper; Xia B, Qian JM, Hu PJ and Li J designed the research; all authors performed the research; Wang F, Ma MX and Li J analyzed the data; Li J and Wang F wrote the paper.
Supported by Grants from the Ministry of Public Health, No. 201002020; and Hubei Provincial Outstanding Medical Academic Leader Program (2013).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bing Xia, Professor, Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan 430071, Hubei Province, China. bingxia@aliyun.com
Telephone: +86-27-87335635 Fax: +86-27-28926781
Received: July 24, 2014
Peer-review started: July 28, 2014
First decision: August 15, 2014
Revised: September 4, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: March 14, 2015
Processing time: 234 Days and 19 Hours
Abstract

AIM: To evaluate clinical response to initial corticosteroid (CS) treatment in Chinese ulcerative colitis patients (UC) and identify predictors of clinical response.

METHODS: Four hundred and twenty-three UC patients who were initially treated with oral or intravenous CS from 2007 to 2011 were retrospectively reviewed at eight inflammatory bowel disease centers in China, and 101 consecutive cases with one-year follow-up were analyzed further for clinical response and predictors. Short-term outcomes within one month were classified as primary response and primary non-response. Long-term outcomes within one year were classified as prolonged CS response, CS dependence and secondary non-response. CS refractoriness included primary and secondary non-response. Multivariate analyses were performed to identify predictors associated with clinical response.

RESULTS: Within one month, 95.0% and 5.0% of the cases were classified into primary response and non-response, respectively. Within one year, 41.6% of cases were assessed as prolonged CS response, while 49.5% as CS dependence and 4.0% as secondary non-response. The rate of CS refractoriness was 8.9%, while the cumulative rate of surgery was 6.9% within one year. After multivariate analysis of all the variables, tenesmus was found to be a negative predictor of CS dependence (OR = 0.336; 95%CI: 0.147-0.768; P = 0.013) and weight loss as a predictor of CS refractoriness (OR = 5.662; 95%CI: 1.111-28.857; P = 0.040). After one-month treatment, sustained high Sutherland score (≥ 6) also predicted CS dependence (OR = 2.347; 95%CI: 0.935-5.890; P = 0.014).

CONCLUSION: Tenesmus was a negative predictor of CS dependence, while weight loss and sustained high Sutherland score were strongly associated with poor CS response.

Keywords: Clinical response; Predictor; Corticosteroid; Ulcerative colitis

Core tip: This is the first large-scale study across mainland China to evaluate clinical response to initial corticosteroid (CS) treatment in ulcerative colitis (UC) and identify predictors of clinical response, although recent studies have focused on the treatment outcomes of new drugs for UC. CS therapy continues to one of the most effective treatments in active UC. In view of the great difference between yellow and white races in CS response, and the lack of large-scale, systematic CS studies in yellow-race UC patients, this study was meaningful in understanding the efficacy of and risk factors for initial CS treatment in yellow-race UC patients.