Analysis of colectomy rates for ulcerative colitis in pre‐ and postbiological eras in Lothian, Scotland

Abstract

Aim Biological treatment is effective in maintaining remission in ulcerative colitis (UC), although the effect on colectomy rates remains unclear. In the UK the use of antitumour necrosis factor and anti‐α4β7 treatments for maintenance therapy in UC was restricted until 2015. The aim of this study was to describe the impact that this change in the prescribing of biologicals had on colectomy rates for UC. Method All patients (adult and paediatric) with a diagnosis of UC who received maintenance biological treatment and/or underwent a colectomy in Lothian, Scotland between 2005 and 2018 were identified. Linear and segmental regression analyses were used to identify the annual percentage change (APC) and temporal trends (statistical joinpoints) in biological prescription and colectomy rates. Results Rates of initiation of maintenance biological therapy increased from 0.05 per 100 UC patients in 2005 to 1.26 in 2018 (p < 0.001). Colectomy rates per 100 UC patients fell from 1.47 colectomies in 2005 to 0.44 in 2018 (p < 0.001). The APC for colectomy decreased by 4.1% per year between 2005 and 2014 and by 18.9% between 2014 and 2018. Temporal trend analysis (2005–2018) identified a significant joinpoint in colectomy rates in 2014 (p = 0.019). Conclusion The use of maintenance biological therapy increased sharply following the change in guidance. This has been paralleled by a significant reduction in the rates of colectomy over the same time period.

Patterns of emergency admission for IBD patients over the last 10 years in Lothian, Scotland: a retrospective prevalent cohort analysis

“…Age-standardised admission rates for IBD have fallen significantly over a period during which there have been substantial increases in biologic use. 6,7 Reassuringly, we have not observed an increase in the risk of severe infection (ITU admission or death) in IBD patients between 2010 and 2020.…”

“…6,7 We have shown the impact of this in a prevalent IBD population with increased biologic prescribing and reduced surgery rates over time. 2,[6][7][8] However, IBD patients are getting older with increased multimorbidity. It is unknown how these changes in treatment practice impact IBD hospital admission in number, rate and cause.…”

The use of, and outcomes for, inflammatory bowel disease services during the Covid‐19 pandemic: a nationwide observational study

“…The evidence regarding UC colectomy rates in recent years is conflicting. Some studies suggest that colectomy rate is decreasing in the era of access to biologic medications 19,20 . However, HES analysis of emergency admissions for UC before the pandemic has demonstrated a decrease in short‐term colectomy rate in recent years that does not persist long‐term 20 .…”

“…Some studies suggest that colectomy rate is decreasing in the era of access to biologic medications. 19 , 20 However, HES analysis of emergency admissions for UC before the pandemic has demonstrated a decrease in short‐term colectomy rate in recent years that does not persist long‐term. 20 The PROTECT‐ASUC found that the practice of gastroenterologists and colorectal surgeons had changed, with more patients receiving rescue therapy in the form of biologicals, ciclosporin or tofacitinib.…”

Lesson from Real-World Experience: Optimal Treatment with Anti-Tumor Necrosis Factor for Ulcerative Colitis

“…Notably, the 1-year colectomy rate of patients with UC receiving anti-TNFs was quite low (1.0%) and similar among anti-TNF agents available in Korea, 5 in line with previous reports. 6 , 7 The major strength of nationwide claims database is to reflect real-world practice. As reported in 2020 inflammatory bowel disease fact sheet in Korea published by the Korean Association for the Study of Intestinal Diseases using the claims data from the National Health Insurance Service, 8 a proportion of UC patients receiving biologics have been increased up to 8% steadily in recent decade while colectomy rates seemed to be declining from 2018 in Korea.…”