Background: Treatment for IBD has two main goals – eliminate symptoms of active disease and maintain remission. For over 50 years clinical studies demonstrate that steroids help induce remission in CD and UC. However, further research demonstrates steroids do not modify disease, they are not able to main remission, only one in three patients have mucosal healing and long-term use can increase adverse reactions.
In 2014, in an effort to optimise the use of steroids in the treatment of IBD in the UK, a collaboration between 14 UK based IBD consultants and nurses and AbbVie resulted in the development of a secure web-based steroid assessment tool SAT, enabling clinicians to monitor steroid use within their clinic setting. The results of this initial study were presented at ECCO 2016 and the British Society of Gastroenterology congress 2016.
Methods: As with the National Steroid Audit, the Kent Steroid Audit used the SAT (Steroid Audit Tool) to collect the data:
In Kent, 3 IBD nurses were keen to work with AbbVie on a collaboration using the SAT. In contrast to the national steroid audit that audited 8 university hospitals and 3 district general hospitals, the Kent IBD audit audited 4 district general hospital.
The 6 district hospitals were selected as each nurse was able to run IBD clinics at each hospital.
Results: 500 IBD patients in Kent were input into the SAT.
Similarly to the National Steroid Audit, a larger proportion of IBD patients in Kent were diagnosed with UC vs. CD.
A higher proportion of IBD-Unknown patients (8%) were reported in Kent steroid audit vs. the National Steroid Audit (3%). Overall, 40% of Kent IBD patients entered into the SAT had received an oral corticosteroid in the past 12 months.
Steroid excess for Kent IBD patients: 28%, 6% of patients had been given 6 or more courses of steroids within 12 months.
National Steroid Audit reported steroid excess: 13.8%.
Conclusions: 500 Kent IBD patients were entered into the SAT which showed 40% of them received an oral corticosteroid in the past 12 months.
The Kent IBD Steroid Audit met its primary objective and reports that within Kent the IBD population in steroid excess of ECCO guidance is more than double the national level 28% in Kent vs. 13.8% nationally.
The SAT also identified inconsistent bone protection between hospital trusts, possibly due to IBD patients hording steroids and not being aware the need to take a bone protection agent, or physicians not prescribing a bone protection agent along side an oral steroid. A Kent IBD pathway has been formalised to incorporate the correct steroid dosages and monitoring. A greater awareness through patient and healthcare professional education has been stated in Kent.