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

Area of Science:

• Gastroenterology
• Immunology
• Clinical Medicine

Background:

• Ulcerative colitis (UC) is increasingly recognized as a progressive condition.
• Unlike Crohn's disease, early biologic therapy (BT) benefits in UC are not well-established.
• Disease progression in UC requires further evaluation to guide treatment strategies.

Purpose of the Study:

• To assess the impact of early intervention on ulcerative colitis (UC) outcomes.
• To determine if early biologic therapy (BT) initiation prevents disease progression.
• To evaluate the long-term effects of early BT on UC structural and clinical endpoints.

Main Methods:

• Retrospective multicenter study of adult UC patients with ≥5 years follow-up.
• Early intervention defined as BT initiation within ≤12 months of diagnosis.
• Primary outcome: UC progression (proximal extension, structural changes, dysplasia/cancer). Secondary outcomes: hospitalizations, surgery, corticosteroid use.

Main Results:

• Late BT initiation independently predicted composite UC progression (HR 4.39, p=0.005).
• Early BT reduced proximal disease extension (28.6% vs 0.0%, p=0.001).
• Late BT predicted colonic structural damage (HR 4.83, p=0.033); no clinical outcome differences observed.

Conclusions:

• Early initiation of biologic therapy (BT) may mitigate long-term disease progression in ulcerative colitis (UC).
• A critical window of opportunity exists for early intervention in UC management.
• Findings support considering early BT to alter the progressive course of UC.