P Kandavel et al. JPGN 2021; 73: 345-351. Reduced Systemic Corticosteroid Use among Pediatric Patients With Inflammatory Bowel Disease in a Large Learning Health System

In this study of 27,321 patients enrolled in the ImproveCareNow (ICN) learning health system, key findings:

• Corticosteroid use decreased from 28% (2007) to 12% (2018)
• Black patients received corticosteroids more commonly than white patients. This disparity improved as corticosteroid use decreased in both groups
• Anti-tumor necrosis factor-alpha medication use <120 days after diagnosis was associated with a reduction in corticosteroid use
• As corticosteroid use decreased, steroid-sparing therapy use increased and height and weight z scores improved, particularly among children with Crohn disease
• 27 centers (31%) had a significant reduction in steroid use, 5 (6%) had a significant increase, and 45 (52%) had variability in steroid use. 9 centers (11%) had <2 years of data.

My take: These findings are expected but nice to see. Patients in the ICN are using less steroids and growing better. Given the variation in care among centers, there is more work needed.

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