Clinical Response for 12 Months or More to the First Advanced Therapy is Associated with a Significant Decrease in the Long-Term Risk of Hospitalization: A Nation-Wide Analysis of Patients From the UK Inflammatory Bowel Disease (IBD) BioResource

Background and Aims It is unclear if a sustained response to the first advanced therapy affects the long-term risk of hospitalization in patients with inflammatory bowel disease (IBD). We have undertaken a retrospective analysis of clinical outcomes using the National Institute for Health and Care Research (NIHR) IBD BioResource database. Methods We included adult patients (≥18 years old) with Crohn disease (CD) or ulcerative colitis (UC) who received treatment with at least 1 advanced therapy. Treatment response was defined as clinical response or remission for 12 months or longer. The outcome was the incidence of IBD-related long-term risk of hospitalization, defined as admission for IBD-related surgery or disease exacerbation requiring intravenous corticosteroids over the duration of follow-up. Results A total of 15 531 patients (CD, 10 024; and UC, 5507) were included in the analysis. Overall, 82% of CD patients and 75.2% of UC patients experienced treatment response to their first advanced treatment. Treatment response to the first advanced therapy initiated was significantly associated with a lower long-term risk of hospitalization in both CD (odds ratio [OR], 0.826; 95% CI, 0.797-0.857) and UC (OR, 0.975; 95% CI, 0.954-0.997). The median (IQR) time (years) for hospitalization In CD responders was 2 (1-4) years and in CD nonresponders was 1.17 (1-3) years, P < .0001 and in UC responders was 1.38 (0.85-3) years and in UC nonresponders was 1 (0.65-2) years, P < .0019. Conclusions Treatment response to the first advanced treatment initiated is significantly associated with a lower long-term risk of hospitalization for IBD. Choosing the best therapy the first time may improve long-term outcomes.