Treatment persistence after switching between anti-tumor necrosis factor agents and tofacitinib in ulcerative colitis: A nationwide claims-based cohort study in South Korea.

Background: The optimal sequencing of advanced therapy in ulcerative colitis (UC) remains unclear. Data comparing different sequencing including the use of tofacitinib as first-line therapy remain scarce. Objectives: We compared the treatment persistence of two therapeutic strategies: anti-tumor necrosis factor (anti-TNF) agents to tofacitinib (A→T) versus tofacitinib to anti-TNF agents (T→A). Design: We conducted a retrospective, nationwide, claims-based cohort study using data from the Korean Health Insurance Review and Assessment database. Methods: We included adult UC patients initiating anti-TNF agents or tofacitinib as first-line therapy. The primary outcome was second-line treatment persistence, using Kaplan-Meier method and multivariable Cox models to estimate adjusted hazard ratios (aHRs). Propensity score matching balanced baseline characteristics. Results: A total of 314 patients were included (A→T, n=273; T→A, n=41). The T→A group was younger (33.0 vs 42.0 years; P=0.02), had lower concomitant use of corticosteroids at first-line therapy (36.59% vs 65.57%; P<0.01), and had shorter duration of total advanced therapy (3.50 vs 4.29 years; P<0.01). After propensity score matching, the persistence of second-line therapy was significantly longer in the A→T group compared with the T→A group (aHR, 2.48; 95% CI, 1.18-5.21; P=0.02), whereas the persistence of first-line therapy did not differ significantly between the two sequences (aHR, 1.18; 95% CI, 0.76-1.85; P=0.46). Progression to third-line therapy occurred more frequently in the T→A group than in the A→T group (41.5% vs 19.8%). Conclusion: In Korean UC patients, switching from anti-TNF agents to tofacitinib was associated with longer second-line treatment persistence than the reverse sequence.