Research Summary

Early vs Delayed Advanced Therapy Among Adult Patients With Moderate Ulcerative Colitis

Anthony Calabro, MA

Adult patients with moderate ulcerative colitis (UC) who received advanced treatment less than 2 years after their diagnosis were more than two times likely to experience endoscopic remission compared with those who delayed receiving advanced treatment.

“An often-overlooked population is patients with UC and moderate disease severity, as this group is frequently combined with patients with severe UC,” the authors wrote.

The goal of the study was to compare the health outcomes of two groups: adult patients with moderate UC who initiated their advanced treatment in less than 2 years after diagnosis (early initiators) and those who initiated their advanced treatment more than 2 years after their moderate UC diagnosis (delayed initiators).

To do this, researchers used data from TARGET-IBD, a real-world observational, longitudinal cohort of patients receiving care for inflammatory bowel disease at one of 34 academic or community-based gastroenterology sites starting in 2017.

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Adult patients with moderate UC who initiated a conventional therapy before advanced treatment, did not use a biologic/Janus kinase for at least 90 days after diagnosis, and did not undergo colectomy for at least 6 months after diagnosis were included in the study. Additionally, participants were included if they experienced one of the following prior to advanced treatment initiation:

  • Abdominal pain and blood in stools
  • Abdominal pain, diarrhea, and stool frequency of at least 4 times a day
  • Mayo endoscopic score of 2

Of the 4474 patients in TARGET-IBD, 179 patients met the criteria for moderate UC. The results indicated that those with early advanced treatment initiation were more likely to have endoscopic remission compared with those who delayed advanced treatment initiation (hazard ratio [HR] = 2.44; 95% confidence interval [CI], 1.19 to 4.97). For early initiators, the median time from advanced treatment initiation to endoscopic remission was shorter compared with the delayed group (10.8 months vs 15.4 months). Patients who initiated an advanced treatment in less than 1 year had about 3.5 times the likelihood of endoscopic remission vs those who initiated an advanced treatment in 2 years or longer (HR = 3.44, [95% CI, 1.45 to 8.15]).

“Among patients with moderate UC, early initiators (less than 2 years after diagnosis) of an [advanced treatment] were more than two times likely to experience endoscopic remission compared with delayed initiators,” the authors concluded. “This suggests that by prioritizing early [advanced treatment], health care providers may be able to optimize clinical outcomes in this group of patients.”

 

Reference:
Rubin DT, Barnes EL, Shweta S, et al. Outcomes of early versus delayed advanced therapy among patients with moderate ulcerative colitis in the United States: TARGET-IBD. Am J Gastroenterol. 2023;118(12S):pS3-S4. doi:10.14309/01.ajg.0000995776.43269.ce