Biologics May Have Changed the Natural History of Ulcerative Colitis

By Megan Brooks

January 30, 2020

NEW YORK (Reuters Health) - The rate of colectomy within the first year after hospital admission for ulcerative colitis has declined in the modern era of biologics, suggesting the advent of biologic therapy has changed the natural history of the disease, researchers report.

"Our data imply optimism that the natural history of needing colon surgery in acute severe ulcerative colitis may be different and modifiable compared to the past," Dr. Fernando Velayos, with Kaiser Permanente San Francisco, told Reuters Health by email.

Dr. Velayos discussed the study last week in Austin, Texas, at the Crohn's and Colitis Congress, sponsored by the Crohn's and Colitis Foundation and the American Gastroenterological Association.

In a phone interview with Reuters Health, Dr. David Rubin, chair of the conference's organizing committee, said, "I do think our improvements in treatments have changed the natural history of the disease and that many patients are now achieving stable control. We are starting to see more and more studies that show we have reduced the rate of surgery."

Using the Kaiser Permanente Northern California database, Dr. Velayos and colleagues studied 524 adults with ulcerative colitis and a first hospitalization between 2009 and 2017.

Results showed that 5.3% of patients underwent colectomy during their first hospitalization for ulcerative colitis and 11.9% underwent colectomy within the first year after hospitalization, compared to rates of 20% and 30%, respectively, in historical controls.

"The main limitations are those typically associated with the electronic database studies, including that although our records are complete, there may have been key information available in outside records. Also, we were unable to obtain details not available electronically, such as the severity of the disease," Dr. Velayos said.

"In general, I think we all have acknowledged that biologics may be behind the decline in rates of colectomy," Dr. Rubin told Reuters Health.

"The opposing hypothesis to explain these observations is that the IBD of the modern age, meaning the last decade or so, is a different type of IBD than the IBD of the 1950s, 60s and 70s. In other words, the growth and emergence of more people who have IBD with no known family history may, in fact, be a milder type of colitis that is environmentally driven but is not as aggressive. I happen to not think that is true," said Dr. Rubin, a professor of medicine at University of Chicago.

"I think we can make a fairly firm statement that the advances in therapies have in fact changed the natural history of the disease and that we are seeing better outcomes across the population now," he added.

The study had no commercial funding and the authors have no relevant conflicts of interest.

SOURCE: http://bit.ly/2NRtYpP Crohn's and Colitis Congress, presented January 23, 2020.

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