Outcomes and prediction of corticosteroid therapy after successive courses of ulcerative colitis treatments.

BACKGROUND: Ulcerative colitis (UC) may require systemic corticosteroid (CS) treatment often without a reliable predictable response, except the Ho-index, used to predict severe cases. The present study aims to determine CS-efficacy and CS-free remission for different courses and longer follow-ups, and a predictive value of CS-outcomes, by the Ho-index and the analysis of clinical variables.

METHODS: An observational retrospective study performed with 136 patients was based on clinical and analytical characteristics, before successive CS-therapies.

RESULTS: The age of UC onset showed three peaks. After the first course, 55.6% were CS-responders, and 39% had CS-free remission by the 3-5-year follow-up. Successive CS-courses presented less efficacy and CS-free remissions, associated with increased CS-use dependence. The Ho-index might only predict the first course of CS and low-score patients with severe UC. Logistic regression analysis gave a predictive response mainly due to the age at diagnosis, the interval from diagnosis to CS-therapy, and C-reactive protein (CRP) or hemoglobin values.

CONCLUSIONS: One-third of the cases were CS-free remission UC. Successive courses showed decreased efficacy and increased CS-dependence, limiting CS-treatment. An older age at diagnosis, longer interval from diagnosis to CS-therapy, lower CRP and higher hemoglobin predicted better prognosis. The accuracy of prediction should be validated and include additional markers.