TOPLINE:

Among patients with ulcerative colitis (UC), initiation of biologic therapy within 12 months of diagnosis was associated with a significantly reduced risk for disease progression, with no proximal extension and fewer structural colonic changes than with late initiation.

METHODOLOGY:

• UC is increasingly recognized as a progressive disease, characterized by proximal extension, structural colonic changes (such as tubularization or strictures), and an increased risk for dysplasia or colorectal cancer; however, the potential preventive benefit of starting early biologic therapy against this progression remains uncertain.
• Researchers in Portugal conducted a multicenter retrospective cohort study involving adult patients with moderate-to-severe UC (defined by a patient-reported outcome 2 score ≥ 3, a Mayo endoscopic subscore ≥ 2, or corticosteroid-dependent or corticosteroid-refractory disease) who initiated biologic therapy for UC activity and had a minimum 5-year follow-up period after initiation.
• Patients were divided into two groups on the basis of the timing of biologic therapy — early intervention (biologic therapy initiated within 12 months of UC diagnosis) and late intervention (biologic therapy initiated more than 12 months after UC diagnosis).
• The primary outcome was disease progression, defined as a composite of proximal extension, structural colonic changes, and dysplasia or cancer.

TAKEAWAY:

• Among 236 patients with UC (median age at diagnosis, 32.0 years; 54.2% female), 68 received early biologic therapy and 168 received late biologic therapy.
• Patients in the early intervention group had a lower cumulative probability of disease progression than those in the late intervention group (10.4% vs 30.7%; P = .003). After adjustment, late intervention was associated with a higher risk for disease progression (hazard ratio [HR], 4.39; P = .005).
• When each outcome was analyzed separately, proximal extension occurred in 17.8% vs 0% of patients in the late intervention group vs the early intervention group; structural changes were more frequent after late vs early initiation of biologic therapy (18.1% vs 2.9%), with late initiation independently predicting structural changes (HR, 4.83; P = .033); the occurrence of dysplasia or cancer did not differ significantly between the groups.
• Early initiation of biologic therapy was not associated with an increased risk for adverse events.

IN PRACTICE:

“Although early intervention did not show significant benefits in clinical outcomes, these outcomes may be improved by reducing corticosteroid overuse and preventing severe and active disease,” the authors of the study wrote. “Regarding disease progression, there appears to be a critical window — within the first 12 months — during which intervention can alter the natural history of UC, redefining the therapeutic window of opportunity.”

SOURCE:

The study was led by Joana Camões Neves, Unidade Local de Saúde de Braga, Braga, Portugal. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Due to the retrospective study design, some data were missing, which may have affected the completeness of the analysis. Disease extent was assessed endoscopically rather than histologically, which may have reduced precision. Additionally, the cohort included only White patients, possibly limiting the generalizability of the findings.

DISCLOSURES:

The study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.