Background: Corticosteroids are widely used in the management of inflammatory bowel disease (IBD) and are associated with significant side effects. The real world effectiveness of newer drug therapies at reducing corticosteroid use is yet to be reported. The overall burden of corticosteroid use is poorly characterized.

Methods: We used a population-based IBD database to evaluate the overall prevalence of corticosteroid exposure, corticosteroid-free survival, and heavy corticosteroid use (≥3000 mg of prednisone or equivalent in a 365-day period). Regression models were used to assess predictors of heavy corticosteroid use and the relationship between corticosteroid dose in the first year after diagnosis and the need for continued corticosteroid use and surgery.

Results: The proportion of persons with IBD prescribed corticosteroids within 1, 5, and 10 years of diagnosis was 35.2%, 52.0%, and 62.8%, respectively. Persons with ulcerative colitis, males, and diagnosis before age 25 were more likely to use corticosteroids and have higher cumulative exposure. Heavy corticosteroid use in the first year after IBD diagnosis was associated with a 3 times increased hazard of resective surgery. Cumulative corticosteroid exposure did not decrease among those diagnosed with IBD in more recent years, despite increasing use of immunomodulators.

Conclusions: A plurality of IBD patients will be exposed to corticosteroids over the course of disease, mostly in the first year. Heavy corticosteroid use in the first year of IBD is a strong predictor of subsequent surgery. Cumulative exposure to corticosteroids use is not decreasing despite increasing uptake of immunomodulators.