Trends in colectomy rates over the past 2 decades reinforced data that biologics may reduce the need for colectomy in ulcerative colitis (UC), a researcher reported here.
A temporal trends analysis found the prevalence of colectomy decreased from 10.8% in 2000 to 2.1% in 2019, and this decline coincided with a linear increase in the prevalence of biologic medication utilization in UC from 0.5% in 2000 to 12.8% in 2019 (P<0.001), according to George Khoudari, MD, of the Cleveland Clinic and Case Western Reserve University.
“Although prior smaller data sets have suggested a decrease, there were no population-based studies to evaluate biologics on colectomy,” senior author Miguel Regueiro, MD, also of the Cleveland Clinic,” said in an interview. “We felt that evaluation of a real world large population-based database would be important.”
Data were extracted from the commercial database Explorys, a repository of electronic health records data from 26 major integrated U.S. healthcare systems from, he explained in a presentation at the American College of Gastroenterology virtual meeting.
Using Systematized Nomenclature of Medicine Clinical Terms, the investigators identified all UC patients older than age 18 to examine the prevalence of UC-related colectomy and biologics utilization. Biologics included anti-tumor necrosis factor, anti-integrin, and anti-interleukin-12/23 agents.
Of 61,592,650 patients in the database, 46,430 were diagnosed with UC from 2000 to 2019. Of these, 15,020 (10.2%) had colectomy and 10,050 (6.8%) were treated with biologics. After adjusting for other therapies such as mesalamine, corticosteroids, and thiopurines, biologics were inversely related to colectomy (P<0.001, respectively, while there was no inverse relationship between mesalamine and colectomy (P<0.001).
According to Regueiro, current data support the effectiveness of earlier use of biologics in the disease course. “Earlier use allows for better rates of healing and less inflammation equates to less likely need for colectomy.” But is it possible that biologics just delay the need for colectomy, especially in severe cases? “For patients hospitalized, which is not the population we studied, yes this is possible,” he said. “However there is some information coming out soon that complete remission of severe cases would also lead to less surgery, not just in the short term but the long term.”
Edward L. Barnes, MD, of the University of North Carolina at Chapel Hill, commented that the study was “an important next step in demonstrating what now appears to be a strong signal of a decreasing colectomy rate in recent years with the increased prevalence of biologic use among UC patients.”
While gastroenterologists have been optimistic that biologics would reduce colectomies, “this was initially only a hope,” said Barnes, who was not involved with the research. The current study as well as others support a genuine effect on colectomy rates.
And given that the new analysis included some of the newest UC treatments, such as anti-integrin and anti-interleukin-12/23 therapies, “there is hope that, with continued advancement of our therapeutic armamentarium, we will see a progression of this trend,” he said.
But Barnes added, “It is important to note that this is just an association, and there may be other explanations that contribute to the decrease,” he told MedPage Today. Other factors could be changes in healthcare delivery or new approaches to care, such as increased access to inflammatory bowel disease specialists and multidisciplinary models.
Khoudari and colleagues said this was the largest study to date using a population-based approach and is consistent with smaller cohort studies. For example, a 2020 study of inpatients at Kaiser Permanente healthcare systems from 2009 to 2017 found a 54% reduction in the number of colectomy procedures in the last 2 years of the study compared with the first year.
“The treatment for ulcerative colitis disease has changed significantly over the past 20 years with biologics being initiated early,” Khoudari said in comments to the press. “We observed a falling trend of colectomy prevalence that coincides with rising trend of biologics utilization. This finding is consistent with previous smaller studies and may suggest that biologic therapy maybe playing a role in the decreasing prevalence of colectomy over the years.
Khoudari disclosed no relevant relationships with industry. Regueiro disclosed relationships with AbbVie and Takeda.
Barnes disclosed no relevant relationships with industry.