Abstract Background Various therapeutic agents are currently available for the treatment of ulcerative colitis (UC) in real-world clinical practice. Patients with UC who do not respond to conventional therapies are often referred to tertiary hospitals, where advanced biologic and small-molecule therapies are indicated. This study aims to investigate the real-world treatment patterns and effectiveness of these advanced agents in patients with UC. This study aimed to evaluate the real-world effectiveness of first- and subsequent-line biologics, Janus kinase (JAK) inhibitors, and sphingosine-1-phosphate (S1P) receptor modulators in patients with ulcerative colitis (UC). Methods This is a retrospective cohort study of patients with UC at our referral center between March 2016 and June 2025. Eligible participants were adults with UC refractory to conventional therapy, having a Mayo endoscopic subscore (MES) ≥2 prior to initiating advanced treatment and a minimum follow-up of 24 weeks. The primary endpoint was corticosteroid-free clinical remission (CSFR) at the last follow-up visit, defined as partial Mayo Score (PMS) ≤2, with rectal bleeding subscore of 0 and no use of any corticosteroids within 90 days before the assessment timepoint. Secondary outcomes included biochemical remission (fecal calprotectin ≤250 μg/g), endoscopic remission (MES of 0), the mean treatment duration, and discontinuation rates. Results A total of 78 patients were included, with a median follow-up duration of 57.8 months after starting the first biologic. Patients underwent 78 courses of advanced therapy (Infliximab 30, Adalimumab 11, Golimumab 8, Vedolizumab 22, Ustekinumab 1, Tofacitinib 2, Filgotinib 2, Ozanimod 2). Sequential therapy was common: 41.0% (32/78) received a second-line agent, 24.4% (19/78) third-line, 12.8% (10/78) fourth-line, and 3.8% (3/78) fifth-line therapy (Table 1, Figure 1). The most common reason for treatment discontinuation was non-response in the first therapy. In patients receiving first-line therapy, the mean treatment duration was 1137.6 days for anti-TNF agents (Group1), 833.7 days for non–anti-TNF agents (Group 2), and 536.7 days for small molecules (Group 3) (Table 1). Infliximab showed a mean first-line treatment duration of 1256.6 days, whereas adalimumab showed a shorter duration of 617.1 days. Overall, 91.0% (71/78) of patients achieved CSFR, 87.2% (68/78) achieved biochemical remission, and 56.4% (44/78) achieved endoscopic remission (Figure 2). Conclusion Advanced biologic and small-molecule therapies were effective and generally well-tolerated in patients with refractory UC. Infliximab showed the most durable first-line treatment response, whereas Adalimumab was associated with a shorter treatment duration. References: 1. Biologic Therapy for Inflammatory Bowel Disease: Real-World Comparative Effectiveness and Impact of Drug Sequencing in 13 222 Patients within the UK IBD BioResource. J Crohns Colitis 2024 Jun 3;18(6):790-800. 2. ACG Clinical Guideline Update: Ulcerative Colitis in Adults Am J Gastroenterol 2025;120:1187–1224. Conflict of interest: Park, Su Bum: No conflict of interest Jang, Jin Ook: No conflict of interest Choi, Cheol Woong: No conflict of interest Kim, Woo Jin: No conflict of interest
Park et al. (Thu,) studied this question.