Invited Editorials

Editorial: early corticosteroids in ulcerative colitis – authors’ reply N. H. Khan*,† & R. M. Almukhtar*,‡,§ *Department of Internal Medicine, Section of Gastroenterology, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA. † Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia VA Medical Center, Philadelphia, PA, USA. ‡ Department of Internal Medicine, Section of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA. § Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. E-mail: [email protected] doi:10.1111/apt.12898

We have also acknowledged in our article that one of the limitations was the lack of endoscopic reports to evaluate disease extent. However, as has been shown in three UC clinical trials involving biologics which required patients to have moderate to severe disease, the majority of the patients who qualified to enroll did not have pancolitis.5–7 We did not have access to hospitalisation data but using intravenous (IV) CS utilization as a proxy for hospitalisation, only five patients used early IV CS per our definition which constituted 0.5% of our sample. In conclusion, we thank Kennedy and Satsangi for their comments and for recognising that this data may help identify those who have an increased risk of disease progression and may benefit from early initiation of more aggressive therapy.

We thank Kennedy and Satsangi for their editorial review of our article.1, 2 They have correctly pointed out that we have used the same cohort as in a previous study.3 However, the two studies are very different. The referenced article investigated thiopurine use and colectomy rates as outcomes based on corticosteroid (CS) use level (one time use, reintroduction or dependency), in addition to reporting the CS use prevalence in the natural history of newly diagnosed ulcerative colitis (UC) patients. We concluded that the cumulative probability of receiving colectomy varied significantly according to the highest CS use level achieved. We have acknowledged in our article that one of the limitations of the study is that it is comprised predominantly of older Caucasian males. While this may impact the overall cumulative probability of requiring a colectomy, the adjusted hazard ratio should be unaffected as we are comparing within the same demographics. Furthermore, our cohort was predominantly composed of late onset UC patients with a median age of diagnosis of 58 years who have been shown to have better response to therapy.4 Thus, it is also unlikely that we would be underestimating the absolute risk of disease complication.

ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2

Editorial: ultra violet (UV) exposure and IBD – should more be done to demonstrate an association before trying to find its mechanism?

Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottinghamshire, UK. E-mail: [email protected]

REFERENCES 1. Kennedy N, Satsangi J. Editorial: early corticosteroids in ulcerative colitis. Aliment Pharmacol Ther 2014; 40: 727–8. 2. Khan NH, Almukhtar RM, Cole EB, Abbas AM. Early corticosteroids requirement after the diagnosis of ulcerative colitis diagnosis can predict a more severe long-term course of the disease – a nationwide study of 1035 patients. Aliment Pharmacol Ther 2014; 40: 374–81. 3. Khan N, Abbas A, Williamson A, Balart L. Prevalence of corticosteroids use and disease course after initial steroid exposure in ulcerative colitis. Dig Dis Sci 2013; 58: 2963–9. 4. Ha CY, Newberry RD, Stone CD, Ciorba MA. Patients with lateadult-onset ulcerative colitis have better outcomes than those with early onset disease. Clin Gastroenterol Hepatol 2010; 8: 682–7. 5. Sandborn WJ, van Assche G, Reinisch W, et al. Adalimumab induces and maintains clinical remission in patients with moderateto-severe ulcerative colitis. Gastroenterology 2012; 142: 257–65. 6. Sandborn WJ, Feagan BG, Marano C, et al. Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology 2014; 146: 85–95. 7. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005; 353: 2462–76.

doi:10.1111/apt.12888

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Aliment Pharmacol Ther 2014; 40: 727-734 ª 2014 John Wiley & Sons Ltd

Editorial: Early corticosteroids in ulcerative colitis--authors' reply.

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