What question did this study set out to answer?

To assess the impact of early intervention on disease outcomes in ulcerative colitis, focusing on disease progression.

January 23, 2026

P0478Early Intervention Prevents Disease Progression in Ulcerative Colitis - Reframing the Window of Opportunity in UC

JNJ Camões NevesHospital Braga DCD A A CostaLocal Government Association DSD Couto SousaAdministração Regional de Saúde de Lisboa e Vale do Tejo

Puntos clave

To assess the impact of early intervention on disease outcomes in ulcerative colitis, focusing on disease progression.
Conducted a retrospective multicenter study across 11 centers.
Included adult ulcerative colitis patients with at least 5 years of follow-up.
Defined early intervention as biologic therapy initiation within 12 months of diagnosis.
Evaluated primary outcome of disease progression at 5 and 10 years using composite endpoints.
Found that late biologic therapy initiation predicted increased disease progression at 5 and 10 years (HR 3.45 and HR 3.12, respectively).
Early biologic therapy significantly reduced the risk of proximal disease extension compared to late initiation (28.6% vs 0.0%).
At 10 years, late initiation was associated with a higher risk of colonic structural damage (HR 4.40).
No differences in clinical outcomes like hospitalizations or corticosteroid use were observed.

Resumen

Abstract Background Ulcerative colitis (UC) has increasingly been recognized as a progressive disease. However, unlike Crohn’s disease (CD), evidence in UC has not demonstrated a clear benefit of early biologic therapy (BT), and disease progression has not been formally evaluated. We aimed to assess whether early intervention improves UC outcomes, particularly in preventing disease progression. Methods We conducted a retrospective multicenter study (11 centers) including adult UC patients with at least 5-years of follow-up (FU). Early intervention was defined as BT initiation within ≤12 months of diagnosis. The primary outcome was UC progression at 5 and 10 years, defined as a composite endpoint including proximal disease extension, colonic structural changes (stenosis or tubularization) and dysplasia/cancer. Secondary outcomes included clinical endpoints: hospitalizations, surgery and corticosteroid use. Results A total of 236 patients were included, 28.8% (n = 68) with early BT median FU: 6.9 (5.8–8.8) years. Late BT initiation independently predicted the composite outcome of progression (23.2% vs 5.9%) at 5 years (HR 3.45; 95% CI 1.04–11.41; p = 0.043) and 10 years (HR 3.12; 95% CI 1.10–8.82; p = 0.032). Assessing each outcome separately, early BT was associated with a reduced risk of proximal extension (28.6% vs 0.0%; p = 0.001). In multivariable Cox regression, late BT initiation was an independent predictor of colonic structural damage (13.1% vs 2,9%) at 10 years (HR 4.40; 95% CI 1.03–18.85; p = 0.046). No differences in clinical outcomes were observed. Conclusion Starting BT early in the disease course may reduce the long-term risk of disease progression, reshaping the window of opportunity in UC. References: 1. Cleveland NK, Torres J, Rubin DT. What does disease progression look like in ulcerative colitis, and how might it be prevented? Gastroenterology 2022;162:1396-1408. 2. Solitano V, et al. Early intervention in ulcerative colitis: ready for prime time? J Clin Med 2020;9:2646. 3. Burisch J, et al. Lack of benefit for early escalation to advanced therapies in ulcerative colitis: critical appraisal of current evidence. J Crohns Colitis 2023;17:2002-2011. Conflict of interest: Ms. Camões Neves, Joana: No conflict of interest Costa, Dalila Amélia Amorim: No conflict of interest Couto Sousa, Diogo: No conflict of interest Neves, Andre: No conflict of interest Fernandes, Samuel Raimundo: No conflict of interest Cristiano, Margarida: No conflict of interest Portela, Francisco: No conflict of interest Costa, Catarina: No conflict of interest Ferreira, Rita: No conflict of interest Portugal, Margarida: No conflict of interest Oliveira, Raquel: No conflict of interest Gututui, Madalina: No conflict of interest Bastos, António: No conflict of interest Santos, Pedro: No conflict of interest Silva, Ana Rita: No conflict of interest Gomes, Plácido: No conflict of interest Damasceno, José: No conflict of interest Guimaraes, Andreia: No conflict of interest Vaz Conde, Patrícia: No conflict of interest Silva Mendes, Sofia: None. Soares, Joao: No conflict of interest Arroja, Bruno: No conflict of interest Goncalves, Raquel: No conflict of interest Leal, Tiago Filipe: No conflict of interest

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