Trends in utilization of advanced therapies in patients with inflammatory bowel diseases in the USA, 2021-2025

Seven new advanced therapies, belonging to three new classes, have been approved for the treatment of inflammatory bowel diseases (IBD) since 2021. We examined trends in utilization of advanced therapies in the USA since 2021.

Using de-identified electronic health record data from 71 US health systems, we examined quarterly trends in utilization of different advanced therapies in patients with ulcerative colitis and Crohn's disease between 2021 and 2025, using interrupted time-series analysis utilizing Prais-Winsten regression.

In 11 093 patients with ulcerative colitis treated with advanced therapies, we observed an increase in use of upadacitinib (12.1% in Q2/2025; P < .001, compared with first quarter of prescription), interleukin-23p19 (IL23p19) antagonists (5.5%; P = .03), and ustekinumab (9.5%; P = .04), decline in use of tumor necrosis factor (TNF) antagonists (34.5%; P = .003), and stable use of vedolizumab (33.6%; P = .17) and sphingosine-1 phosphate receptor modulators (1.6%; P = .28). In 15 951 patients with Crohn's disease treated with advanced therapies, we observed an increase in use of IL23p19 antagonists (15.0% in Q1/2025; P = .003) and upadacitinib (5.9%; P < .001) and decline in use of TNF antagonists (50.2%; P = .001) and ustekinumab (13.5%; P < .001).

Contemporary trends in advanced therapy utilization in patients with IBD suggest an increased utilization of upadacitinib and anti-interleukins, accompanied by a decline in use of TNF antagonists in the USA.