Colectomy Rates did not Decrease in Paediatric- and Adult-Onset Ulcerative Colitis During the Biologics Era: A...

Area of Science:

• Gastroenterology
• Clinical Medicine
• Epidemiology

Background:

• The impact of biologic therapies on the natural history of ulcerative colitis (UC) remains debated.
• This nationwide study examines long-term UC outcomes during the biologic era in Israel.

Purpose of the Study:

• To evaluate trends in long-term outcomes for ulcerative colitis patients diagnosed since the advent of biologic therapies.
• To assess the influence of biologics on surgery, hospitalization, and steroid-dependency rates in UC.

Main Methods:

• Utilized data from the epi-IIRN cohort, covering 98% of the Israeli population, linked to national registries.
• Employed Joinpoint Regression and Kaplan-Meier survival analyses to determine annual average percentage change (AAPC) for key outcomes.
• Analyzed outcomes across different age groups, including paediatric-onset, adult, and elderly patients.

Main Results:

• Biologic utilization in UC increased significantly from 0.1% in 2005 to 9.6% in 2019, with earlier prescription trends observed.
• Annual rates of surgeries (AAPC -1.3%) and steroid-dependency (AAPC -1.2%) remained stable.
• Hospitalization rates showed a slight decrease (AAPC -1.2%), but outcomes were poorer in paediatric-onset UC despite higher biologic use.

Conclusions:

• Biologic therapies have not significantly changed the rates of surgery or steroid-dependency in ulcerative colitis patients.
• A slight reduction in hospitalizations was observed during the biologic era.
• Paediatric-onset UC patients experienced worse outcomes compared to adults, even with increased biologic therapy utilization.