TOPLINE:

In patients with inflammatory bowel disease (IBD), a response to the first advanced therapy lasting 12 months or more was associated with a reduced risk for hospitalisation due to surgery or rescue treatment; responders experienced a significantly longer time to hospitalisation than non-responders.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis using a national database to assess the link between treatment response to the first biologic exposure and long-term surgery and hospitalisation outcomes in the UK population.
• They analysed data of 15,531 adults recruited from hospitals (January 2017 to October 2023), including 10,024 patients with Crohn's disease and 5507 patients with ulcerative colitis (UC).
• These patients received at least one advanced therapy, including infliximab, adalimumab, golimumab, ustekinumab, vedolizumab, risankizumab, mirikizumab, tofacitinib, upadacitinib, filgotinib, ozanimod, and etrasimod.
• Treatment response to the advanced therapy was defined as clinical remission or clinical response with a sustained benefit for more than 12 months.
• The primary outcome was the incidence of hospitalisations due to IBD-related luminal surgery or exacerbation needing intravenous corticosteroids. These complications were compared between patients who responded to treatment and those who did not.

TAKEAWAY:

• Overall, 82% of patients with Crohn's disease and 75.2% of those with UC responded to the first advanced therapy. Moreover, responders had a longer median time to hospitalisation than non-responders (2 vs 1.17 years; P < .0001 for those with Crohn's disease and 1.38 vs 1 year; P < .0019 for those with UC).
• Treatment response to therapies, including infliximab, adalimumab, and vedolizumab, was linked to a lower risk for hospitalisation in patients with Crohn's disease (odds ratio [OR], 0.826; 95% CI, 0.797-0.857) and those with UC (OR, 0.975; 95% CI, 0.954-0.997).
• Among patients with Crohn's disease, those who responded to vedolizumab (OR, 0.885; 95% CI, 0.860-0.913) and ustekinumab (OR, 0.871; 95% CI, 0.827-0.917) exhibited a lower risk for hospitalisation due to surgery or exacerbations requiring intravenous corticosteroids than those who responded to infliximab.
• Among patients with UC, those who responded to vedolizumab (OR, 0.963; 95% CI, 0.952-0.974) and adalimumab (OR, 0.982; 95% CI, 0.965-0.998) demonstrated a lower risk for hospitalisation than those who responded to infliximab.

IN PRACTICE:

"Special attention should be given to the choice of the first advanced treatment, a consideration that raises the issue that the most effective therapy should be used first rather than later in a more rescue fashion," the authors of the study wrote.

SOURCE:

This study was led by Kaung Yan, MSc, University of Nottingham, Nottingham, England. It was published online on December 02, 2025, in Inflammatory Bowel Diseases.

LIMITATIONS:

This study was non-randomised, and treatment selection was influenced by physician judgement. Data on disease activity and severity, newer biologics, and oral small molecules were lacking. Effects of dose adjustments of biologics and concomitant immunomodulators were not assessed.

DISCLOSURES:

This work was supported by Janssen Global Services. Several authors reported receiving research support/funding, education grants, and/or speaker or consulting fees and serving as consultants on advisory boards for various pharmaceutical companies. Three authors reported being employees of the funding company.

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