Healthcare providers underestimate patients' Glucocorticoid use in Crohn's Disease

Subrata Ghosh, Brian Bressler, Jill Petkau, Roopal B. Thakkar, Song Wang, Martha Skup, Jingdong Chao, Remo Panaccione, Stefan Schreiber

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
219 Downloads (Pure)


BACKGROUND: One of the therapy goals for Crohn's disease (CD) is glucocorticoid-free remission. Studies have shown care setting-specific variations in inflammatory bowel disease (IBD) management.

AIMS: The principal objective of this study was to assess concordance between patient-reported and physician-reported outcomes in two different care settings (IBD centers and community practices).

METHODS: Data of overall and long-term (≥ 3 months) glucocorticoid, immunosuppressant, and biologics use in participants ≥ 18 years old with a confirmed diagnosis of CD were collected. HCPs were grouped by IBD centers and community practices. Quality of life (using EuroQol 5D [EQ-5D]) and work/activity days lost were assessed. Agreement between patients' and HCPs' responses to survey questions was tested using kappa statistics.

RESULTS: Data from 812 patients were examined. Significantly more patients versus HCPs reported oral glucocorticoid use (25.9% vs. 20.8%, κ = 0.735, P < 0.0001). Long-term use of oral glucocorticoids was similar for patients versus HCPs (67.7% vs. 63.8%, κ = 0.598, P = 0.53). Immunosuppressant use was 52.4% vs. 51.1% (κ = 0.784) and biologics use was 49.5% vs. 47.0% (κ = 0.909) for patients vs. HCPs. Patients and HCPs reported greater rates of symptom improvement with vs without biologic therapy (patients: 33.3% vs 16.8%; HCPs: 29.3% vs 13.5%, both P < 0.001). Patients with versus without routine follow-up were less likely to be treated with long-term glucocorticoid monotherapy (10.3% vs. 20.7%, P < 0.01) and had fewer lost work/activity days (5 vs. 8 days, P < 0.05).

CONCLUSIONS: Patients reported more oral glucocorticoid use than physicians thought. Routine follow-up and higher rates of biologic use are associated with improvement in disease symptoms and general health among patients with CD.

Original languageEnglish
Article number5419
Pages (from-to)1142-1149
Number of pages8
JournalDigestive Diseases and Sciences
Issue number5
Early online date19 Jan 2019
Publication statusPublished - May 2019

Bibliographical note

Ghosh, S., Bressler, B., Petkau, J. et al. Dig Dis Sci (2019).


  • Crohn’s disease
  • Glucocorticoids
  • Patient-reported outcomes
  • Physician-reported outcomes
  • Quality of life

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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