Introduction: Ulcerative colitis (UC) is a heterogeneous and unpredictable disease with the potential for disease worsening over time and should be regarded as a progressive disease. More recent evidence and clinical practice guidelines suggest that biologic therapy is a preferred initial therapy in treating moderate to severe UC. However, despite these guidelines, little research has been done to determine the optimal timing for the initiation of biologic therapy. Data on the impact of early intervention in UC are limited, and whether more intensive treatments prevent structural and functional complications is still debated. We hypothesize that early initiation of biologic therapy (specifically within 2 years of diagnosis) will lead to fewer UC-related complications and higher response rates.
Methods: We conducted a retrospective cohort study of UC patients treated within the Military Health System to assess the relationship of timing of initiation of biologic therapy with the control of ulcerative colitis. Data was collected from the military’s universal electronic health record from January 1, 2013 to December 30, 2020 to measure the course of patients’ disease as determined by clinical, biochemical, radiologic, and endoscopic/histologic findings, with an assessment of clinical outcomes and complications to include UC-related emergency room visits, steroid use, hospitalizations, and surgeries.
Results: 371 patients with UC were identified, of which 181 were started on biologic therapy within 2 years of diagnosis, while 190 were started on biologic therapy 2 or more years after diagnosis. Patients who initiated biologic therapy within 2 years of diagnosis had significantly fewer UC-related complications (p< 0.0001) (Image 1a). Extensive disease at diagnosis was also predictive of a decreased likelihood of a composite of UC-related complications (Image 1b). Patients with lower Mayo scores were also more likely to experience UC-related complications (Image 1c).
Discussion: These findings demonstrate that earlier initiation of biologics (within 2 years of diagnosis) results in a lower probability of UC-related complications, including emergency room visits, steroid use, hospitalizations, and surgeries. This study also suggests that even patients with minimal disease and lower Mayo scores on diagnosis could benefit from early biologic therapy.
