Rate of Colectomy Increases Within 12 Months of Sequential Therapy for Ulcerative Colitis.

Abstract

Patients with medically refractory ulcerative colitis who previously would have undergone surgery can now elect for subsequent medical therapy. In a commercially insured population, we evaluated the proportion of patients initiating second-line, third-line, or fourth-line treatment who underwent colectomy in the following 12 months. Among 3,325 patients with ulcerative colitis, the colectomy rate within 12 months of a switch in therapy increased from 12% with the first switch to 17% and 19% with the second and third switches, respectively ( P < 0.001). Treatment effectiveness declines with successive switching; however, even after initiating fourth-line therapy, most patients remain surgery-free.