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Summary
Background
Endoscopic healing (EH) is a therapeutic target in ulcerative colitis (UC). However, even patients who have achieved EH relapse frequently.
Aims
To investigate the association between recent steroid use and relapse risk in UC patients with EH.
Methods
This multi‐centre cohort study included 1212 UC patients with confirmed EH (Mayo endoscopic subscore ≤1). We excluded patients with current systemic steroid use or history of advanced therapy. We divided patients into a recent steroid group (last systemic steroid use within 1 year; n = 59) and a non‐recent or steroid‐naïve group (n = 1153). We followed the patients for 2 years to evaluate relapse, defined as induction of systemic steroids or advanced therapy. We used logistic regression to estimate the odds ratio (OR) of relapse.
Results
Relapse occurred in 28.8% of the recent steroid group and 5.6% of the non‐recent/steroid‐naïve group (multi‐variable‐adjusted OR 5.53 [95% CI 2.85–10.7]). The risk of relapse decreased with time since the last steroid use: 28.8% for less than 1 year after steroid therapy, 22.9% for 1 year, 16.0% for 2 years and 7.9% beyond 3 years, approaching 4.0% in steroid‐naïve patients. (ptrend <0.001).
Conclusions
Even for patients with UC who achieved EH, the risk of relapse remains high following recent steroid therapy. Physicians need to consider the duration since last steroid use to stratify the relapse risk in UC patients with EH.
Among patients with ulcerative colitis who had used steroids and achieved endoscopic healing, the risk of relapse decreased with each subsequent year, approaching that of steroid‐naive patients.