TBA (21W162)

Trends in Colectomy Rates and Biologic use over a 30-year period: What has changed?

Author(s)

J Doherty, P Girod, M Buckley, G Cullen, G Horgan, E Mc Dermott, H Mulcahy, J Sheridan, D Kevans, G Doherty

Department(s)/Institutions

Centre for Colorectal Disease, St Vincent’s University Hospital & School of Medicine, University College Dublin, Dublin 4.

Introduction

Novel medications including the introduction of biologic therapies in the last decade have expanded treatment options for patients with ulcerative colitis (UC).

Aims/Background

Large studies in the USA and Europe have shown colectomy rates in UC patients are reducing over the past two decades.

Method

We performed a single-centre retrospective study of our prospectively maintained IBD database. Our aim was to look at changes in colectomy rates in patients with UC over the past three decades and need for biologic therapy. Basic demographics, need for biologic therapy and colectomy rates were collected. Need for colectomy and biologic therapy within 10 years of diagnosis was determined across three groups dependent on decade of diagnosis.

Results

2229 patients with confirmed UC were included in our study. Median age at diagnosis was 37 years [range 4.9 -92.6]. 1210 [54.28%] were male. 595 patients were diagnosed between 1990-2000, 795 between 2000-2010 and 790 between 2010-2020. A total of 366 (16.4%) patients had a colectomy during follow-up and 363 (16.3%) were treated with biologic therapies. We found rates of colectomy within 10 years of diagnosis have significant dropped over the past three decades. From 1990 -2000 595 patients were diagnosed with UC and 131 [22%] patients had colectomies, in 2000-2010 794 patients were diagnosed with UC and 135 [17%] had a colectomy and between 2010-2020 784 patients were diagnosed with UC and 55 [7%] had a colectomy [p = < 0.001]. We found a significant increase in use of biologic therapy within the first 10-years of diagnosis over the last three decades increasing from 0.2% to 5.3% to 22.7% over the past decades [p = < 0.001].

Conclusions

Management of UC has changed over the past three decades including the introduction of multiple biologic therapies and the use of therapeutic drug monitoring has allowed a more personalised approach to management of UC. We can see from this study changes in the management of UC over the past decade have resulted in significant reduction in need for colectomy and an increase in the use of biologics.