Short disease duration is associated with increased risk of treatment failure in biologic-Treated patients with ulcerative colitis

Nghia H. Nguyen, Soumya Kurnool, Parambir S. Dulai, Brigid S. Boland, William J. Sandborn, Siddharth Singh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Longer disease duration is associated with inferior response to biologic therapy in Crohn s disease. However, the effect of disease duration on response to biologic therapy in ulcerative colitis (UC) has not been well studied. Methods: In a single-center retrospective cohort study of outpatients with UC starting a biologic agent, we evaluated treatment response by disease duration. The primary outcome was treatment failure (composite outcome of inflammatory bowel disease [IBD] related surgery/hospitalization or treatment modification including dose escalation, treatment discontinuation, or addition of corticosteroids); secondary outcomes were risk of IBD-related surgery/hospitalization and endoscopic remission. We conducted multivariate Cox proportional hazard analyses to evaluate the independent impact of disease duration on clinical outcomes. Results: We included 160 biologic-Treated UC patients (73% biologic-naive) with a median age (interquartile range) of 36 (26 52) years and disease duration (range) of 4.5 (1 9) years. After adjusting for immunosuppressive medications, albumin, and body mass index, each 1-year increase in disease duration was associated with a 5% lower risk of treatment failure (adjusted hazard ratio, 0.95; 95% confidence interval [CI], 0.91 0.99) and a 9% higher risk of achieving endoscopic remission (adjusted odds ratio, 1.09; 95% CI, 1.01 1.18). This association of short disease duration with treatment failure was observed only in biologic-naive patients, but not biologic-experienced patients. No significant association was seen between disease duration and risk of surgery or hospitalization. Conclusion: Shorter disease duration is independently associated with increased risk of treatment failure in biologic-Treated patients with UC. Requirement of biologic therapy early in the course of disease may be a negative prognostic marker in patients with UC.

Original languageEnglish (US)
Pages (from-to)1429-1435
Number of pages7
JournalInflammatory bowel diseases
Volume26
Issue number9
DOIs
StatePublished - Sep 1 2020
Externally publishedYes

Keywords

  • Disease duration
  • IBD
  • prognosis
  • treatment failure

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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