Understanding the Shift in Ulcerative Colitis Therapy Sequences Across Diagnostic Era: A Multicenter Retrospective I-BRITE Study

Objective: In recent years, an increasing number of advanced therapies (ADTs) have been approved for ulcerative colitis (UC). With multiple treatment options, understanding prescribing patterns is essential to optimize therapeutic strategies. This study aimed to assess trends in UC treatment and clinical outcomes based on data from major medical facilities in Ibaraki Prefecture. Methods: This multicenter study including 13 hospitals was approved by the ethics committees of all participating hospitals. The primary endpoint was to evaluate trends in UC therapies and outcomes based on the diagnostic era. The diagnostic era was categorized into six 5-year intervals (Era 1 to Era 6), with Era 6 representing the most recent period (up to June 30, 2023). Results: The study included 1,867 UC patients. Classical therapy patterns remained stable, with aminosalicylates followed by steroids and thiopurines. The most common first- and second-line ADTs were infliximab and golimumab in Eras 1-5, but in Era 6, vedolizumab became the most common first-line ADT, with ustekinumab often selected as a second. The interval between first steroid and ADT use shortened over time. No significant differences in colorectal neoplasia or colectomy rates were observed. Conclusion: The evolving ADT patterns and the shift toward early steroid use followed by ADTs may reflect the broader availability of safer treatments.