Early Intervention Prevents Disease Progression in Ulcerative Colitis: A Multicenter Retrospective Study

Ulcerative colitis (UC) has increasingly been recognized as a progressive disease. However, unlike Crohn's disease, evidence in UC has not demonstrated a clear benefit of early biologic therapy (BT), and disease progression has not been formally evaluated. We aimed to assess whether early intervention improves UC outcomes, particularly in preventing disease progression.

We conducted a retrospective multicenter study (11 centers) including adult patients with UC with at least 5 years of follow-up. Early intervention was defined as BT initiation within ≤12 months of diagnosis. The primary outcome was UC progression, defined as a composite endpoint including proximal disease extension, colonic structural changes (stenosis or tubularization), and dysplasia/cancer. Secondary outcomes included clinical endpoints: hospitalizations, surgery, and corticosteroid use.

A total of 236 patients were included, 28.8% (n = 68) with early BT (median follow-up, 6.9 years; interquartile range, 5.8-8.8 years). Late BT initiation (23.2% vs 5.9%) independently predicted the composite outcome of progression (hazard ratio, 4.39; 95% confidence interval, 1.57-12.29; P = .005). Assessing each outcome separately, early BT was associated with a reduced risk of proximal extension (28.6% vs 0.0%; P = .001). In multivariable Cox regression, late BT initiation (13.1% vs 2,9%) was an independent predictor of colonic structural damage (hazard ratio, 4.83; 95% confidence interval, 1.14-20.58; P = .033). No differences in clinical outcomes were observed.

Starting BT early in the disease course may reduce the long-term risk of disease progression, reshaping the window of opportunity in UC.