Twenty-Year Trends in Colectomy Rates and Advanced Therapy Prescribing in Lothian, Scotland

The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with conflicting published evidence.

To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023.

We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise linear regression analyses to identify temporal trends in prescription and colectomy rates.

The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates.

The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.