Corticosteroid use in post-op CD

June 17, 2025

Issue 12

Clinical Question

Does primary ileocaecal resection reduce systemic corticosteroid use in patients with Crohn’s disease?

Editor’s Bottom Line

Ileocecal resection for Crohn’s disease has steroid-sparing effects. These data support surgical intervention for selected patients but do not directly compare medical vs. surgical strategies.

Reference

Hjälte V, Myrelid P, Hjortswang H, et al. Substantial Reduction of Systemic Corticosteroid Use After Primary Ileocaecal Resection in Swedish Patients with Crohn’s Disease: A Population-Based Cohort Study. Aliment Pharmacol Ther. 2025;61:1649–61. https://doi.org/10.1111/apt.70069

Synopsis

This population-based cohort study from Sweden examined systemic corticosteroid use before and after primary ileocecal resection in 1,565 patients with Crohn’s disease who underwent the procedure between 2006–2019. The patients were included in the Swedish National Patient Register and National Prescribed Drug Register.

Patients were stratified according to mean annual systemic corticosteroid use (prednisolone equivalents) in the five years before surgery, defined as low users (<1,000 mg/year), intermediate users (≥1,000 to <2,000 mg/year) or high users (≥2,000 mg/year).

Patients were a median 28.9 years of age at the time of IBD diagnosis and 37 years of age at the time of ileocaecal resection. The median disease duration at the time of surgery was 3.7 years, and 49% of patients were female. Sixty-two percent of patients were exposed to immunomodulators before surgery and 32% had used biologics. Median follow-up was 6.8 years.

In the five years preceding surgery, 19% (290/1,565) of patients had a mean annual corticosteroid use ≥1,000 mg prednisolone equivalents, with 6% (97/1,565) using ≥2,000 mg annually. Mean annual pre-operative corticosteroid use was 547 mg prednisolone equivalents per patient and remained consistent throughout the study period, showing no decline despite the increasing availability of biologics.

Higher corticosteroid users were more frequently exposed to immunomodulators (83% vs. 56% in low users) and biologics (38% vs. 29% in low users) and were more likely to have a history of bowel surgery (16% vs. 10% in low users).

Following ileocecal resection, patients with pre-operative mean annual corticosteroid use ≥1,000 mg experienced a substantial reduction of 1,354 mg annually (1,847 mg pre-operative vs. 493 mg post-operative). High users showed the most dramatic reduction, with a mean decrease of 2,280 mg prednisolone equivalents per patient per year, equivalent to an average reduction of 1.8 steroid courses yearly. The mean corticosteroid use in high users dropped from 3,306 mg the year before surgery to 803 mg the year after.

Among intermediate and high users, 80% and 88%, respectively, shifted to low corticosteroid use (<1,000 mg annually) during the five-year post-operative period. Among patients with three or more consecutive years of corticosteroid use exceeding 2,000 mg before surgery (n=59), roughly 75% shifted to the low use category post-operatively.

Roughly 25% of patients were exposed to systemic corticosteroids in the 90 days before primary ileocecal resection. These patients were younger at both diagnosis and surgery, more often exposed to immunomodulators (69% vs. 58%), and had higher mean five-year pre-operative corticosteroid use (1,097 vs. 367 mg/patient/year).

During follow-up, 6.3% of all patients underwent ileocolic re-resection. Exposure to systemic corticosteroids within 90 days prior to the ileocecal resection was associated with increased risk of ileocolic re-resection (Hazard Ratio: 1.64; 95% Confidence Interval [CI], 1.13–2.59; p=0.036) and with post-operative corticosteroid use (Odds Ratio: 1.57; 95% CI, 1.05–2.36; p=0.030).

During the five years following ileocecal resection, 46% of patients received biologics, with exposure patterns remaining consistent across the three pre-operative corticosteroid use groups.

 

Details

Study Design: Population-based cohort study
Funding: Regional Council of Region Östergötland, Sweden
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b