The Leeds Steroids in IBD study
Research type
Research Study
Full title
Steroid excess in Inflammatory Bowel Disease: Origins of prescriptions, primary care-secondary care interaction and treatment escalation
IRAS ID
235324
Contact name
Christian Selinger
Contact email
Duration of Study in the UK
3 years, 8 months, 28 days
Research summary
Corticosteroids are considered an important tool in the management of disease flares for patients with Inflammatory Bowel Disease (IBD); yet have no efficacy in the maintenance of remission. However, corticosteroids are well known to have significant short and long term side effects, leading both the British Society of Gastroenterology and the European Crohn’s and Colitis Organisations guidelines to clearly define steroid dependent disease and advise treatment escalation for all steroid dependent patients.
It has recently been demonstrated that 30% of IBD patients are exposed to steroids each year and that 14% of IBD patients are steroid dependent or receive steroid courses in excess of guideline recommendations. A study involving 1177 patients has further demonstrated that over half of steroid excess is potentially avoidable. In 23 of 162 patients excess steroid prescriptions had originated from primary rather than secondary care. This is likely to be an underestimation as researchers did not have access to primary care prescription data and depended on patient recall of prescriptions.
IBD is a complex disease with increasing treatment options that are potentially better managed in secondary care. Anecdotally steroid prescriptions from primary care are often inappropriately dosed and often are shorter than recommended. Furthermore there is concern that these prescription are often not communicated to the IBD team and hence opportunities for appropriate treatment escalation are missed. These have however not been robustly investigated to quantify their prevalence and provide the data needed for informing GP’s and IBD teams of the need for more joined up approaches to patient management. The proposed study will examine comprehensive care records from primary and secondary care of patients under the Leeds IBD service. The aim of the study is to determine steroid prescription practice comprehensively across primary and secondary care using hospital and linked community healthcare (GP) databases. We also aim to assess the outcomes associated with excessive or inappropriate steroid use, identify predictors of steroid excess and quantify the origins of steroid prescription from primary and secondary care sources and see what proportion of primary care prescriptions are communicated to the secondary care team.REC name
London - City & East Research Ethics Committee
REC reference
18/LO/0635
Date of REC Opinion
17 Apr 2018
REC opinion
Favourable Opinion