Advanced therapy treatment patterns in moderate-to-severe ulcerative colitis: a long-term retrospective claims analysis.

Background: There has been significant evolution in advanced therapy (AT) options for moderate-to-severe ulcerative colitis (UC). We assessed shifts in treatment patterns over time using a large claims database with long-term follow-up. Methods: This retrospective study utilized the IQVIA PharMetrics Plus claims database (2012-2023) to analyze adults in the United States with UC who initiated an AT. Patients had ≥3 years of continuous follow-up after AT initiation and no evidence of other autoimmune diseases during the six-month baseline period. Treatment patterns including persistence, switching, and/or discontinuation were summarized. Analyses were stratified by year of AT initiation: 2012-2014, 2015-2016, 2017-2018, and 2019-2020. Results: 6726 patients with a mean follow-up of 61.5 months and treatment duration of 22.9 months (SD: 14.2) were included. Vedolizumab usage increased over time in parallel with a reduction in anti-TNF therapy. Around 27%-34% of patients had dose escalation and 40% switched ATs at some point during follow-up. AT treatment persistence rates at 3 years of follow-up were <40% across all time periods, and <10% when limiting to patients who did not require dose escalation and/or steroids. Approximately 57% of patients in routine practice discontinued AT and did not start a subsequent AT. Conclusion: Despite the availability of multiple new AT options for UC, rates of steroid-free persistence without the need for dose escalation were low. High rates of treatment discontinuation across lines of therapy highlight a need for durable treatment options.