P0623Prescribing patterns and persistence of advanced therapies in people with Ulcerative Colitis who are bio-experienced: Insights from the Crohn’s Colitis Care (CCCare) registry

Abstract Background As therapeutic options for ulcerative colitis (UC) expand, real-world data are needed to understand durability of different advanced therapies (ADV) beyond initial treatment lines. Longer-term outcomes in bio-experienced individuals remain poorly characterised. We evaluated persistence—a pragmatic measure of ongoing effectiveness across six ADVs—in bio experienced people with UC and assessed predictors of persistence. Methods Prospectively collected routine-care data from the Crohn’s Colitis Care (CCCare) registry were analysed. Adults with UC and prior ADV exposure who commenced a subsequent maintenance course (standard or dose-escalated) of adalimumab (ADA), infliximab (IFX), ustekinumab (UST), vedolizumab (VDZ), upadacitinib (UPA) or tofacitinib (TOF) were included. All courses up to 30 October 2025 were eligible. The primary outcome was treatment persistence, assessed with Kaplan–Meier curves; predictors of persistence were evaluated using univariate and multivariable Cox models. Results A total of 402 maintenance courses were analysed in 280 individuals. Median age at course commencement was 35.5 years; 52.0% were in males. Median disease duration was 7.7 years and follow-up 4.9 years. Most had left-sided or extensive colitis. Courses were predominantly second-line (66.4%), and 41.8% were dose-escalated from initiation, most commonly with UPA (61.2%, p 0.001). UPA and UST were the most common second-line agents (22.8% and 23.2%) while later lines were increasingly dominated by UPA (47.4% third-line; 37.5% fourth-line). Concomitant 5-ASA use in UPA (24%) was significantly lower than IFX (45%), VDZ (47.7%) and ADA (55.6%; p 0.001). Concomitant IMS use in UPA (4.1%) was the lowest across therapies, though not significantly different from TOF (12.0%). In the bio-experienced cohort, 24-month persistence ranged from 43.6% (ADA) to 69.7% (VDZ), without a significant difference between therapies (p = 0.16). In pairwise Cox analyses, subsequent therapy with VDZ showed a consistent trend toward lower discontinuation risk versus other ADVs (HRs 0.51–0.61), although none reached statistical significance. In multivariable modelling, independent predictors of discontinuation were dose escalation (HR 1.84, 95% CI 1.10–3.11) and concomitant systemic steroid use (HR 1.71, 1.14–2.55). Conclusion In this large, multicentre real-world UC cohort, no ADV as second or subsequent choice demonstrated superior persistence, although VDZ had a non-significant trend toward greater persistence. Dose escalation at initiation and systemic steroid use were strong predictors of shorter persistence, identifying individuals with more severe or higher-risk disease who may benefit from proactive monitoring and treatment optimisation. Conflict of interest: Wu, Rodger: No conflicts Ghali, Mark: No conflicts. Wilson, William: No conflict of interest Caquilpan, Victor: No conflict of interest Rivas, Consuelo: No conflict of interest Lynch, Kate: Kate Lynch has received speaker honoraria, advisory board fees, and/or conferencetravel/registration support from AbbVie, Bristol-Myers Squibb (BMS), Chiesi, Dr. Falk, Ferring, Gilead, Guidepoint, Intercept Pharmaceuticals, Janssen-Cilag, Merck Sharp & Dohme (MSD), Norgine, Pfizer, Pliant, Sandoz, Takeda, and the Royal Adelaide Hospital (RAH) Research Fund. Haifer, Craig: Grant: Grants from St Vincent’s Clinic Foundation, Gastroenterological Society of Australia, Gutsy Group, Royal Australasian College of Physicians and Ferring. Personal Fees: CH has received speaker fees and educational support from Janssen, Pfizer, Takeda, Ferring and Abbvie. Walker, Gareth: In the last 24 months, Dr Walker has received investigator grants or served as a speaker, a consultant or an advisory board member for: Janssen AbbVie Takeda Ferring Dr Falk Pharma Georgiamune Radford-Smith, Graham Lindsay: No conflict of interest Lawrance, Ian Craig: No conflict of interest Begun, Jakob: I have received honoraria or consulting fees from Abbvie, Janssen, Takeda, Pfizer, Ferring, Bristol Myers Squibb, Gilead, Tillott’s, Sandoz, Celltrion, Chiesi, Dr Falk, Microba, Glaxo Smith Klein, Antara, Suono, Therpeutic Guidelines, Research Review,Grants: NHMRC, US Department of Defence, The Gutsy Foundation, The Gastroenterological Society of Australia, The University of Queensland, The Viertel Foundation, and The Mater Foundation Wark, Gabrielle: Conference travel/registration support from Dr Falk Verdon, Christine: No conflict of interest Andrews, Jane Mary: Grant: The work I will present was funded svia CCCure. CCCure’s funding sources include grants for research and payments for data reports from Pharma including AbbVie, J & J, Takeda, Celltrion, Falk, Ferring, BMS, Janssen, Pfizer, Sandoz Ghaly, Simon: Speaker fees, research grants and travel grants from Dr. Falk pharma, Janssen, Pfizer, AbbVie, Sandoz and Ferring and served on advisory boards for Pfizer and AbbVie. Connor, Susan Jane: Grant: Research Support: Abbvie, Agency for Clinical Innovation, Amgen, BMS, Chiesi, Celltrion, Dr Falk, Ferring, Janssen, Medical Research Future Fund, Pfizer, South Western Sydney Local Health District, Sydney Partnership for Health, Research and Enterprise, Takeda and The Leona M and Harry B Helmsley Charitable Trust Personal Fees: Ad Boards: Abbvie, Amgen, BMS, Celltrion, Eli Lilly, Ferring, GSK, Janssen, Organon, Pfizer, Takeda Speaker Fees: Abbvie, Cornerstones Health, Dr Falk, Ferring, Janssen, Pfizer, Sandoz, Sydney IBD School, Takeda Educational Support: DrFalk, Sandoz, Takeda