P1145Temporal trends in advanced therapy use for ulcerative colitis in the public healthcare system in Brazil: a nationwide populationb-based study

Background Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease (IBD). Over the past two decades, biologic agents and small molecules (advanced therapies) have revolutionized IBD treatment. However, most data on the use of these medications come from Europe and North America, with limited information available for Brazil. Our aim was to describe temporal trends in the use of biologics and small molecules among UC patients treated within Brazil’s public healthcare system over the years as well as to compare differences in medication use, individually and across different regions of the country. Methods A retrospective, population-based observational study was conducted using records from the DATASUS platform. The study period spanned from January 2019 to December 2023. All patients registered on the platform with an International Classification of Diseases (ICD) code for UC were included. Patients were then categorized by type of advanced therapy used (infliximab, vedolizumab, or tofacitinib). Dispensing rates for each medication were recorded in absolute numbers and as a proportion of the total number of UC patients in the country, month by month for the study period. Results By the end of 2023, 195,807 patients with UC had been identified in Brazil. The prevalence of UC increased from 26.34 per 100,000 in 2019 to 64.39 per 100,000 in 2023. Nationwide, the use of biologics and small molecules grew exponentially, with vedolizumab showing the highest percentage increase with an Annual Average Percent Change (AAPC) of + 8.5% (95% CI: 8.1–9.0), followed by tofacitinib [AAPC = +4.8% (95% CI: 3.5–6.2)] and infliximab [AAPC = +1.02% (95% CI: 0.7–1.4)]. The regional analysis revealed important differences: while the Southeast concentrated the largest increases in the use of the three drugs, the Northeast was the only region to show a significant reduction in the use of vedolizumab, infliximab, and tofacitinib. Conclusion Conclusions: There was a significant increase in UC prevalence from 2019 to 2023, especially in the Southeast region, which recorded the highest concentration of patients, followed by the South. The Southeast also showed the highest prevalence of use for all three drugs analyzed. Vedolizumab had the greatest proportional increase nationwide, followed by tofacitinib and infliximab. The lowest usage rates for all three drugs were observed in the North and Northeast regions, where a decrease in the use of advanced therapies was particularly noted. References: Savio MC, Coelho JC, Oliveira E, Magro DO. Nationwide trends in colectomy rates for ulcerative colitis in Brazil: an analysis of the unified public healthcare system. Gastroenterol Hepatol. 2025 Mar 20;502434.2) Quaresma AB, Guedes LR, Barros JR, Baima JP, Imbrizi M, Zerôncio MA, et al. Structural evaluation of inflammatory bowel disease comprehensive care units in Brazil: GEDIIB. Arq Gastroenterol. 2024 Mar 15;61:e23166. Conflict of interest: Villamil, Maria Paz Gimenez: No conflict of interest Bein, Maria VIctoria: No conflict of interest Proenca de Moraes, Thyago: No conflict of interest Molteni, Rafaela: No conflict of interest Savio, Mariane Christine: Johnson and Johnson, Abbvie Valverde, Douglas Andreas: No conflict of interest Quaresma, Abel: Speaker Jansen and Celltrion Kotze, Paulo Gustavo: Grant: Pfizer, Takeda Personal Fees: Abbvie, Johnson & Johnson, Ferring, Pfizer, Takeda, Celltrion Other: Abbvie, Janssen, Ferring, Pfizer, Takeda