TOPLINE

Among patients with inflammatory bowel disease (IBD), 30% received biologic agents or JAK inhibitors within 5 years. Treatment with biologics or JAK inhibitors was associated with a lower risk for hospitalisation in both patients with Crohn's disease (CD) and ulcerative colitis (UC).

METHODOLOGY

• Researchers conducted a prospective, observational, incident cohort study in Spain to assess the clinical course of IBD through 5 years of follow-up, including the need for surgery, frequency of hospitalisations, and patterns of treatment.
• They included 3301 adult patients with newly diagnosed IBD (median age at diagnosis, 43 years; 52.5% men), of whom 1526 had CD (median age at diagnosis, 40.9 years), 1633 had UC (median age at diagnosis, 45.6 years), and 142 had unclassified IBD (median age at diagnosis, 47.2 years).
• Disease location and phenotypes were classified, and data on IBD treatments were recorded, with only the first prescription of each drug class captured. Early exposure to treatments was defined as treatment started within 6 months of diagnosis.
• The researchers assessed data on surgeries related to IBD performed before or after diagnosis and hospital admissions associated with IBD from diagnosis through 5 years of follow-up.

TAKEAWAY

• During the follow-up, 30% of patients received biologics or JAK inhibitors, 34% were hospitalised, and 9% had at least one surgery (60% abdominal and 40% perianal surgeries). Patients with CD had a higher cumulative incidence of hospitalisations and surgery than those with UC or unclassified IBD.
• Exposure to biologics or JAK inhibitors was linked to a lower risk for hospitalisation among both patients with CD (hazard ratio [HR], 0.4; P < .001) and UC (HR, 0.5; P = .027). Early exposure, but not late exposure, to biologics or JAK inhibitors was associated with a higher risk for abdominal surgery in those with UC (HR, 11.9; 95% CI, 4.6-30.4), and both early and late exposures were not linked to the risk for surgery in those with CD.
• In patients with CD, predictors associated with the use of biologics or JAK inhibitors were younger age at diagnosis (HR, 0.99), a family history of IBD (HR, 1.3), smoking (HR, 1.3), stricturing (HR, 1.9) and fistulising (HR, 2.3) behaviours, and perianal disease at diagnosis (HR, 1.9; P < .05 for all).
• Among patients with UC, those with left-sided colitis and those with pancolitis showed a greater use of biologics or JAK inhibitors and a higher risk for hospitalisations than those with proctitis (P < .001 for all).

IN PRACTICE

"[O]ur results reinforce the need to improve patient stratification through clinical tools and biomarkers aiming to more accurately identify, at an early stage, those patients who will benefit from intensive therapies, with the goal of significantly altering the natural history of their IBD," the authors wrote.

SOURCE

This study was led by Ana Garre, Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain. It was published online on October 11, 2026, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS

The possibility of selection bias related to participating centres cannot be completely ruled out. Excluded patients showed different characteristics, especially age; thus, complete-case samples might lack full representativeness of eligible cohorts, and a potential selection bias cannot be ruled out. Data on switches from one drug to another within therapeutic groups were not systematically recorded.

DISCLOSURES

This study was supported by grants from the Instituto de Salud Carlos III, Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa, and MSD. One author reported receiving support from Gobierno Vasco-Eusko Jaurlaritza. Several authors declared receiving research support or research funding, consultancy fees, or financial support for travelling and educational activities and/or serving as speakers, consultants, or advisory board members for different medical device, pharmaceutical, and biopharmaceutical companies including MSD.

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