Abstract Background Ulcerative colitis (UC) is a chronic relapsing inflammatory disease affecting the large bowel. There is an increasing incidence and prevalence in Asian countries, with a shift towards younger patients in high income regions. More than half of UC patients present with moderate disease; despite this, studies have suggested a less than 2% use of advanced therapies (AT). Methods This was a retrospective, observation study conducted in Singapore General Hospital. The clinical, biochemical and endoscopic characteristics of UC patients in Singapore General Hospital who were initiated on AT from Jan 2022 to Jan 2025 were studied. Clinical response was defined as a reduction of modified Mayo score from baseline by ≥ 2 points, with either a reduction of at least 1 point in the rectal bleeding (RB) subscore or an absolute RB subscore of ≤ 1. Clinical remission was defined as a Mayo score of 2 points or lower with RB score of 0. Biochemical remission was defined as CRP 5µg/mL or FC 250μg/g. Endoscopic response was defined as improvement of Mayo Endoscopic Score (MES) of =1 and remission as MES 0. Results From 2022 to 2025, a total of 161 AT initiation or modifications were recorded for 100 UC patients. Fifty-seven (57%) were male; the median age of diagnosis was 37 (26-54) and median BMI was 23.9(21-27). Eighty-two (82%) were non-smokers. Fifty-four (54%) of the UC patients had extensive disease, 36 (36%) were left sided and 10 (10%) were proctitis. Fourteen (14%) patients presented with acute severe UC. The median duration of disease was 5 years. Of the 89 UC patients that underwent pre-escalation endoscopy, 57 (64%) had MES 3 colitis. Within the study period, 27 (27%) patients required a change in AT; 14 (14%) required 3 or more changes. The most common first line therapy initiated was Vedolizumab (VDZ), followed by infliximab (IFX). A switch from first line therapy during the study period occurred in 13/37 (35.1%), 11/29 (37.9%), 9/20 (45%) of patients on VDZ, IFX and ADA respectively. Of note, VDZ demonstrated high clinical and biochemical remission rates within the induction period which was significant compared to Adalimumab (ADA) (OR 2.92, p = 0.013) but not for Infliximab (IFX) or Ustekinumab (UST). JAK-inhibitors were predominantly used as second or third line therapies but demonstrated nearly 100% treatment persistence, with only one UC patient switching from TFC to VDZ as third line therapy. Breakdown of demographics and usage of AT are detailed in Table 1. Figure 1 is a Sankey diagram depicting the transition of AT between lines of therapy. Conclusion VDZ, IFX and UST are effective first line AT for UC, but VDZ had higher persistence up to 52 weeks. JAK-inhibitors appear to be effective second and third line salvage therapies. Reference: Niriella MA, Martinus CK, Withanage MY, et al. “Clinical epidemiology of inflammatory bowel disease among adults in the South Asian region: A systematic review and meta-analysis”. Heliyon. 2025;11(3):e41840. Published 2025 Jan 11. doi:10.1016/j.heliyon.2025.e41840 Conflict of interest: Wee, Poh Hui: No conflict of interest to declare Ho Ren Yi, Jonas: No conflict of interest ng, Jun Jie Jareth: No conflict of interest Tan, Malcolm: No conflict of interest Salazar, Ennaliza: No conflict of interest Lim, Chong Teik: No conflict of interest Tay, Shu: No conflict of interest Leong, Justin: No conflict of interest Dr. Tan, Yi Yuan: No conflict of interest
Wee et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: