Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice
Identifieur interne : 004835 ( Ncbi/Merge ); précédent : 004834; suivant : 004836Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice
Auteurs : Shomron Ben-Horin ; Jane M. Andrews ; Konstantinos H. Katsanos ; Florian Rieder ; Flavio Steinwurz ; Konstantinos Karmiris ; Jae Hee Cheon ; Gordon William Moran ; Monica Cesarini ; Christian D. Stone ; Doron Schwartz ; Marijana Protic ; Xavier Roblin ; Giulia Roda ; Min-Hu Chen ; Ofir Har-Noy ; Charles N. BernsteinSource :
- World Journal of Gastroenterology [ 1007-9327 ] ; 2017.
Abstract
To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates (5ASA) with corticosteroids (CS) versus corticosteroids alone for patients with active ulcerative colitis (UC).
A cross-sectional questionnaire exploring physicians’ attitude toward 5ASA + CS combination therapy
Six hundred and sixty-four questionnaires were distributed and 349 received (52.6% response rate). Of 340 eligible respondents, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA (
Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.
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DOI: 10.3748/wjg.v23.i16.2995
PubMed: 28522918
PubMed Central: 5413795
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice</title><author><name sortKey="Ben Horin, Shomron" sort="Ben Horin, Shomron" uniqKey="Ben Horin S" first="Shomron" last="Ben-Horin">Shomron Ben-Horin</name></author><author><name sortKey="Andrews, Jane M" sort="Andrews, Jane M" uniqKey="Andrews J" first="Jane M" last="Andrews">Jane M. Andrews</name></author><author><name sortKey="Katsanos, Konstantinos H" sort="Katsanos, Konstantinos H" uniqKey="Katsanos K" first="Konstantinos H" last="Katsanos">Konstantinos H. Katsanos</name></author><author><name sortKey="Rieder, Florian" sort="Rieder, Florian" uniqKey="Rieder F" first="Florian" last="Rieder">Florian Rieder</name></author><author><name sortKey="Steinwurz, Flavio" sort="Steinwurz, Flavio" uniqKey="Steinwurz F" first="Flavio" last="Steinwurz">Flavio Steinwurz</name></author><author><name sortKey="Karmiris, Konstantinos" sort="Karmiris, Konstantinos" uniqKey="Karmiris K" first="Konstantinos" last="Karmiris">Konstantinos Karmiris</name></author><author><name sortKey="Cheon, Jae Hee" sort="Cheon, Jae Hee" uniqKey="Cheon J" first="Jae Hee" last="Cheon">Jae Hee Cheon</name></author><author><name sortKey="Moran, Gordon William" sort="Moran, Gordon William" uniqKey="Moran G" first="Gordon William" last="Moran">Gordon William Moran</name></author><author><name sortKey="Cesarini, Monica" sort="Cesarini, Monica" uniqKey="Cesarini M" first="Monica" last="Cesarini">Monica Cesarini</name></author><author><name sortKey="Stone, Christian D" sort="Stone, Christian D" uniqKey="Stone C" first="Christian D" last="Stone">Christian D. Stone</name></author><author><name sortKey="Schwartz, Doron" sort="Schwartz, Doron" uniqKey="Schwartz D" first="Doron" last="Schwartz">Doron Schwartz</name></author><author><name sortKey="Protic, Marijana" sort="Protic, Marijana" uniqKey="Protic M" first="Marijana" last="Protic">Marijana Protic</name></author><author><name sortKey="Roblin, Xavier" sort="Roblin, Xavier" uniqKey="Roblin X" first="Xavier" last="Roblin">Xavier Roblin</name></author><author><name sortKey="Roda, Giulia" sort="Roda, Giulia" uniqKey="Roda G" first="Giulia" last="Roda">Giulia Roda</name></author><author><name sortKey="Chen, Min Hu" sort="Chen, Min Hu" uniqKey="Chen M" first="Min-Hu" last="Chen">Min-Hu Chen</name></author><author><name sortKey="Har Noy, Ofir" sort="Har Noy, Ofir" uniqKey="Har Noy O" first="Ofir" last="Har-Noy">Ofir Har-Noy</name></author><author><name sortKey="Bernstein, Charles N" sort="Bernstein, Charles N" uniqKey="Bernstein C" first="Charles N" last="Bernstein">Charles N. Bernstein</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28522918</idno><idno type="pmc">5413795</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413795</idno><idno type="RBID">PMC:5413795</idno><idno type="doi">10.3748/wjg.v23.i16.2995</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002D46</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002D46</idno><idno type="wicri:Area/Pmc/Curation">002B96</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002B96</idno><idno type="wicri:Area/Pmc/Checkpoint">000390</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000390</idno><idno type="wicri:Area/Ncbi/Merge">004835</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice</title><author><name sortKey="Ben Horin, Shomron" sort="Ben Horin, Shomron" uniqKey="Ben Horin S" first="Shomron" last="Ben-Horin">Shomron Ben-Horin</name></author><author><name sortKey="Andrews, Jane M" sort="Andrews, Jane M" uniqKey="Andrews J" first="Jane M" last="Andrews">Jane M. Andrews</name></author><author><name sortKey="Katsanos, Konstantinos H" sort="Katsanos, Konstantinos H" uniqKey="Katsanos K" first="Konstantinos H" last="Katsanos">Konstantinos H. Katsanos</name></author><author><name sortKey="Rieder, Florian" sort="Rieder, Florian" uniqKey="Rieder F" first="Florian" last="Rieder">Florian Rieder</name></author><author><name sortKey="Steinwurz, Flavio" sort="Steinwurz, Flavio" uniqKey="Steinwurz F" first="Flavio" last="Steinwurz">Flavio Steinwurz</name></author><author><name sortKey="Karmiris, Konstantinos" sort="Karmiris, Konstantinos" uniqKey="Karmiris K" first="Konstantinos" last="Karmiris">Konstantinos Karmiris</name></author><author><name sortKey="Cheon, Jae Hee" sort="Cheon, Jae Hee" uniqKey="Cheon J" first="Jae Hee" last="Cheon">Jae Hee Cheon</name></author><author><name sortKey="Moran, Gordon William" sort="Moran, Gordon William" uniqKey="Moran G" first="Gordon William" last="Moran">Gordon William Moran</name></author><author><name sortKey="Cesarini, Monica" sort="Cesarini, Monica" uniqKey="Cesarini M" first="Monica" last="Cesarini">Monica Cesarini</name></author><author><name sortKey="Stone, Christian D" sort="Stone, Christian D" uniqKey="Stone C" first="Christian D" last="Stone">Christian D. Stone</name></author><author><name sortKey="Schwartz, Doron" sort="Schwartz, Doron" uniqKey="Schwartz D" first="Doron" last="Schwartz">Doron Schwartz</name></author><author><name sortKey="Protic, Marijana" sort="Protic, Marijana" uniqKey="Protic M" first="Marijana" last="Protic">Marijana Protic</name></author><author><name sortKey="Roblin, Xavier" sort="Roblin, Xavier" uniqKey="Roblin X" first="Xavier" last="Roblin">Xavier Roblin</name></author><author><name sortKey="Roda, Giulia" sort="Roda, Giulia" uniqKey="Roda G" first="Giulia" last="Roda">Giulia Roda</name></author><author><name sortKey="Chen, Min Hu" sort="Chen, Min Hu" uniqKey="Chen M" first="Min-Hu" last="Chen">Min-Hu Chen</name></author><author><name sortKey="Har Noy, Ofir" sort="Har Noy, Ofir" uniqKey="Har Noy O" first="Ofir" last="Har-Noy">Ofir Har-Noy</name></author><author><name sortKey="Bernstein, Charles N" sort="Bernstein, Charles N" uniqKey="Bernstein C" first="Charles N" last="Bernstein">Charles N. Bernstein</name></author></analytic><series><title level="j">World Journal of Gastroenterology</title><idno type="ISSN">1007-9327</idno><idno type="eISSN">2219-2840</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>AIM</title><p>To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates (5ASA) with corticosteroids (CS) versus corticosteroids alone for patients with active ulcerative colitis (UC).</p></sec><sec><title>METHODS</title><p>A cross-sectional questionnaire exploring physicians’ attitude toward 5ASA + CS combination therapy <italic>vs</italic> CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents’ agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses.</p></sec><sec><title>RESULTS</title><p>Six hundred and sixty-four questionnaires were distributed and 349 received (52.6% response rate). Of 340 eligible respondents, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA (<italic>P</italic> < 0.001), and 11 (3%) are undecided. Similarly, 62% would continue 5ASA in an out-patient starting oral CS. However, only 140/340 (41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most (94%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS.</p></sec><sec><title>CONCLUSION</title><p>Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Gastroenterol</journal-id><journal-id journal-id-type="iso-abbrev">World J. Gastroenterol</journal-id><journal-id journal-id-type="publisher-id">WJG</journal-id><journal-title-group><journal-title>World Journal of Gastroenterology</journal-title></journal-title-group><issn pub-type="ppub">1007-9327</issn><issn pub-type="epub">2219-2840</issn><publisher><publisher-name>Baishideng Publishing Group Inc</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28522918</article-id><article-id pub-id-type="pmc">5413795</article-id><article-id pub-id-type="other">jWJG.v23.i16.pg2995</article-id><article-id pub-id-type="doi">10.3748/wjg.v23.i16.2995</article-id><article-categories><subj-group subj-group-type="heading"><subject>Observational Study</subject></subj-group></article-categories><title-group><article-title>Combination of corticosteroids and 5-aminosalicylates or corticosteroids alone for patients with moderate-severe active ulcerative colitis: A global survey of physicians' practice</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ben-Horin</surname><given-names>Shomron</given-names></name></contrib><contrib contrib-type="author"><name><surname>Andrews</surname><given-names>Jane M</given-names></name></contrib><contrib contrib-type="author"><name><surname>Katsanos</surname><given-names>Konstantinos H</given-names></name></contrib><contrib contrib-type="author"><name><surname>Rieder</surname><given-names>Florian</given-names></name></contrib><contrib contrib-type="author"><name><surname>Steinwurz</surname><given-names>Flavio</given-names></name></contrib><contrib contrib-type="author"><name><surname>Karmiris</surname><given-names>Konstantinos</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cheon</surname><given-names>Jae Hee</given-names></name></contrib><contrib contrib-type="author"><name><surname>Moran</surname><given-names>Gordon William</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cesarini</surname><given-names>Monica</given-names></name></contrib><contrib contrib-type="author"><name><surname>Stone</surname><given-names>Christian D</given-names></name></contrib><contrib contrib-type="author"><name><surname>Schwartz</surname><given-names>Doron</given-names></name></contrib><contrib contrib-type="author"><name><surname>Protic</surname><given-names>Marijana</given-names></name></contrib><contrib contrib-type="author"><name><surname>Roblin</surname><given-names>Xavier</given-names></name></contrib><contrib contrib-type="author"><name><surname>Roda</surname><given-names>Giulia</given-names></name></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Min-Hu</given-names></name></contrib><contrib contrib-type="author"><name><surname>Har-Noy</surname><given-names>Ofir</given-names></name></contrib><contrib contrib-type="author"><name><surname>Bernstein</surname><given-names>Charles N</given-names></name></contrib><aff>Shomron Ben-Horin, Ofir Har-Noy, Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat-Gan 52621, Israel</aff><aff>Shomron Ben-Horin, Min-Hu Chen, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510700, Guangdong province, China</aff><aff>Jane M Andrews, Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Service, Royal Adelaide Hospital, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia</aff><aff>Konstantinos H Katsanos, Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece</aff><aff>Florian Rieder, Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44109, United States</aff><aff>Flavio Steinwurz, Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, SP 05652-900, Brazil</aff><aff>Konstantinos Karmiris, Department of Gastroenterology, Venizeleio General Hospital, Heraklion, 71409 Crete, Greece</aff><aff>Jae Hee Cheon, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea</aff><aff>Gordon William Moran, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham NG7 2UH, United Kingdom</aff><aff>Monica Cesarini, Dipartimento di Medicina Interna e Specialità Mediche, “Sapienza”, University of Rome, 00185 Roma, Italy</aff><aff>Christian D Stone, Comprehensive Digestive Institute of Nevada, Las Vegas, NV 89113, United States</aff><aff>Doron Schwartz, Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 6400111, Israel</aff><aff>Marijana Protic, Department of Gastroenterology, University Hospital Zvezdara, Belgrade 11000, Serbia</aff><aff>Xavier Roblin, Department of Gastroenterology, University-Hospital of Saint-Etienne, 42100 Saint Etienne, France</aff><aff>Giulia Roda, Gastroenterology Unit, S. Orsola-Malpighi, 40138 Bologna, Italy</aff><aff>Charles N Bernstein, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB R3T2N2, Canada</aff></contrib-group><author-notes><fn><p>Author contributions: Ben-Horin S designed the study and drafted the manuscript; Andrews JM, Katsanos KH, Rieder F, Steinwurz F, Karmiris K, Cheon JH, Moran GW, Cesarini M, Stone CD, Schwartz D, Protic M, Roblin X, Roda G, Chen MH, Har-Noy O and Bernstein CN collected the results, participated in data analysis and interpretation and in critical review of the manuscript for important intellectual content.</p><p>Correspondence to: Shomron Ben-Horin, MD, Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Hashomer, Ramat-Gan 52621, Israel. <email>shomron.benhorin@gmail.com</email></p><p>Telephone: +972-3-5302694 Fax: +972-3-5303160</p></fn></author-notes><pub-date pub-type="ppub"><day>28</day><month>4</month><year>2017</year></pub-date><pub-date pub-type="epub"><day>28</day><month>4</month><year>2017</year></pub-date><volume>23</volume><issue>16</issue><fpage>2995</fpage><lpage>3002</lpage><history><date date-type="received"><day>25</day><month>12</month><year>2016</year></date><date date-type="rev-recd"><day>31</day><month>1</month><year>2017</year></date><date date-type="accepted"><day>15</day><month>3</month><year>2017</year></date></history><permissions><copyright-statement>©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.</license-p></license></permissions><abstract><sec><title>AIM</title><p>To examine treatment decisions of gastroenterologists regarding the choice of prescribing 5-aminosalycilates (5ASA) with corticosteroids (CS) versus corticosteroids alone for patients with active ulcerative colitis (UC).</p></sec><sec><title>METHODS</title><p>A cross-sectional questionnaire exploring physicians’ attitude toward 5ASA + CS combination therapy <italic>vs</italic> CS alone was developed and validated. The questionnaire was distributed to gastroenterology experts in twelve countries in five continents. Respondents’ agreement with stated treatment choices were assessed by standardized Likert scale. Background professional characteristics of respondents were analyzed for correlation with responses.</p></sec><sec><title>RESULTS</title><p>Six hundred and sixty-four questionnaires were distributed and 349 received (52.6% response rate). Of 340 eligible respondents, 221 (65%) would continue 5ASA in a patient hospitalized for intravenous CS treatment due to a moderate-severe UC flare, while 108 (32%) would stop the 5ASA (<italic>P</italic> < 0.001), and 11 (3%) are undecided. Similarly, 62% would continue 5ASA in an out-patient starting oral CS. However, only 140/340 (41%) would proactively start 5ASA in a hospitalized patient not receiving 5ASA before admission. Most (94%) physicians consider the safety profile of 5ASA as very good. Only 52% consider them inexpensive, 35% perceive them to be expensive and 12% are undecided. On multi-variable analysis, less years of practice and perception of a plausible additive mechanistic effect of 5ASA + CS were positively associated with the decision to continue 5ASA with CS.</p></sec><sec><title>CONCLUSION</title><p>Despite the absence of data supporting its benefit, most gastroenterologists endorse combination of 5ASA + CS for patients with active moderate-to-severe UC. Randomized controlled trials are needed to assess if 5ASA confer any benefit for these patients.</p></sec></abstract><kwd-group><kwd>Inflammatory bowel disease</kwd><kwd>Corticosteroids</kwd><kwd>5-aminosalicylates</kwd><kwd>Ulcerative colitis</kwd></kwd-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Andrews, Jane M" sort="Andrews, Jane M" uniqKey="Andrews J" first="Jane M" last="Andrews">Jane M. Andrews</name><name sortKey="Ben Horin, Shomron" sort="Ben Horin, Shomron" uniqKey="Ben Horin S" first="Shomron" last="Ben-Horin">Shomron Ben-Horin</name><name sortKey="Bernstein, Charles N" sort="Bernstein, Charles N" uniqKey="Bernstein C" first="Charles N" last="Bernstein">Charles N. Bernstein</name><name sortKey="Cesarini, Monica" sort="Cesarini, Monica" uniqKey="Cesarini M" first="Monica" last="Cesarini">Monica Cesarini</name><name sortKey="Chen, Min Hu" sort="Chen, Min Hu" uniqKey="Chen M" first="Min-Hu" last="Chen">Min-Hu Chen</name><name sortKey="Cheon, Jae Hee" sort="Cheon, Jae Hee" uniqKey="Cheon J" first="Jae Hee" last="Cheon">Jae Hee Cheon</name><name sortKey="Har Noy, Ofir" sort="Har Noy, Ofir" uniqKey="Har Noy O" first="Ofir" last="Har-Noy">Ofir Har-Noy</name><name sortKey="Karmiris, Konstantinos" sort="Karmiris, Konstantinos" uniqKey="Karmiris K" first="Konstantinos" last="Karmiris">Konstantinos Karmiris</name><name sortKey="Katsanos, Konstantinos H" sort="Katsanos, Konstantinos H" uniqKey="Katsanos K" first="Konstantinos H" last="Katsanos">Konstantinos H. Katsanos</name><name sortKey="Moran, Gordon William" sort="Moran, Gordon William" uniqKey="Moran G" first="Gordon William" last="Moran">Gordon William Moran</name><name sortKey="Protic, Marijana" sort="Protic, Marijana" uniqKey="Protic M" first="Marijana" last="Protic">Marijana Protic</name><name sortKey="Rieder, Florian" sort="Rieder, Florian" uniqKey="Rieder F" first="Florian" last="Rieder">Florian Rieder</name><name sortKey="Roblin, Xavier" sort="Roblin, Xavier" uniqKey="Roblin X" first="Xavier" last="Roblin">Xavier Roblin</name><name sortKey="Roda, Giulia" sort="Roda, Giulia" uniqKey="Roda G" first="Giulia" last="Roda">Giulia Roda</name><name sortKey="Schwartz, Doron" sort="Schwartz, Doron" uniqKey="Schwartz D" first="Doron" last="Schwartz">Doron Schwartz</name><name sortKey="Steinwurz, Flavio" sort="Steinwurz, Flavio" uniqKey="Steinwurz F" first="Flavio" last="Steinwurz">Flavio Steinwurz</name><name sortKey="Stone, Christian D" sort="Stone, Christian D" uniqKey="Stone C" first="Christian D" last="Stone">Christian D. Stone</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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