Increased failure of budesonide MMX for ulcerative colitis during the COVID-19 pandemic: a population-based study.

BACKGROUND

Corticosteroids induce remission in ulcerative colitis (UC) but are associated with adverse effects, including prednisone ⩾20 mg/day associated with serious COVID-19 outcomes.

OBJECTIVES

To evaluate the risk of rescue prednisone use following budesonide multimatrix system (MMX) initiation in newly diagnosed individuals with UC before and during the COVID-19 pandemic.

DESIGN

Population-based cohort study.

METHODS

We conducted a population-based study in Alberta, Canada, identifying adults with incident UC (2018-2022). Courses of budesonide MMX were examined for treatment failure, defined as prednisone rescue or inflammatory bowel disease-specific hospitalization within 90 days. Outcomes were compared between prepandemic (before April 2020) and pandemic periods using Cox proportional hazards models.

RESULTS

Among 269 dispensings of budesonide MMX (38 with multiple courses), 30.5% required rescue prednisone and 6.7% resulted in hospitalization. Budesonide MMX dispensing declined during the pandemic wherein, the hazard of prednisone rescue increased (HR 1.64; 95% CI: 1.01-2.67).

CONCLUSION

Budesonide MMX was prescribed less frequently during the COVID-19 pandemic, with increased treatment failure, underscoring pandemic-related disruptions in UC management.