Abstract Background Despite well-recognized safety concerns, corticosteroids (CS) remain a cornerstone of induction therapy for ulcerative colitis (UC). While effective for short-term disease control, the long-term implications of extended CS exposure to UC management are unclear, particularly in Asian populations where UC incidence is rising rapidly and clinical evidence remains scarce. Methods This retrospective cohort study utilized data from the Sir Run Run Shaw Hospital Inflammatory Bowel Disease Biobank in China. Adults with confirmed UC who initiated CS (2014-2024) were included. The index date was defined as CS initiation date, with baseline set as the prior year. Excess CS use, assessed during a 6-month screening period following the study index, was defined as either 1 episode or cumulative exposure 120 days. An episode was continuous CS use until a treatment gap of ≥ 14 days occurred. Follow-up began after the screening period and continued until the last available record. Outcomes included UC admission, colectomy, and counts of different advanced treatments (ADV, including biologics and Janus kinase inhibitors) during follow-up. Inverse probability treatment weighting was applied to balance baseline characteristics, including demographics, index year, smoking/alcohol status, UC disease activity, UC diagnosis and admission histories. Weighted Cox and negative binomial regression were used to estimate associations. Results Among 1,412 screened UC patients, 401 met the inclusion criteria (mean age 44.4 years; 58.1% male; 10.0% current smokers or alcohol users; 93.1% with moderate/severe UC; 40.4% had disease duration 1 year; 28.4% had UC admission at baseline; mean follow-up: 1300.0 days). Excess CS use was identified in 59.6% (mean exposure: 150.2 days). During follow-up, UC admission occurred more frequently in the excess group vs non-excess (41.4% vs 27.2%), colectomy in 12.1% vs 6.7%, and use of ADV in 37.2% vs 26.5%. Weighted regression analysis showed excess CS use was associated with higher risk of UC admission (HR: 1.62; 95% CI: 1.27–2.07; p 0.01), more UC admissions overall (IRR: 1.95; 95% CI: 1.23–3.08; p 0.01), as well as increased risk of colectomy (HR: 2.50; 95% CI: 1.42–4.41; p 0.01) and greater ADV use (IRR: 1.53; 95% CI: 1.03–2.26; p = 0.03). These associations remained consistent after adjustment for immunomodulators, advanced treatments, and UC admission during the screening period. Conclusion Excess CS use within 6 months of initiation, observed in a Chinese healthcare setting, was independently associated with elevated risks of subsequent colectomy and UC admission, as well as greater use of advanced treatments, underscoring the need for early identification and steroid-sparing approaches to improve patient outcomes. Conflict of interest: Yang, Wenjing: No conflict of interest Yao, Lingya: No conflict of interest Wu, Tao: Tao Wu is an employee of Johnson & Johnson Shu, Meng: Meng Shu is an employee of Johnson & Johnson Gao, Han: Han Gao is an employee of Johnson & Johnson Zhang, Yongjing: Yongjing Zhang is an employee of and reports stock ownership to Johnson & Johnson Cao, Qian: No conflict of interest
Yang et al. (2026) studied this question.