Clinical Assistant-Hospitalist Cleveland Clinic Foundation Cleveland, OH
Award: Presidential Poster Award
George Khoudari, MD1, Emad Mansoor, MD2, Ahmed Eltelbany, MD, MPH1, Mohannad Abou Saleh, MD1, Jeffry Katz, MD3, Gregory Cooper, MD2, Miguel Regueiro, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 3University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: Ulcerative colitis (UC) treatment has changed significantly over the past 20 years with biologics initiated earlier. Recent reports suggest that early use of biologics may decrease colectomy rates. Our study investigates the trends of colectomy and biologic use UC patients from 2000-2019. Methods: We used a commercial database (Explorys Inc, Cleveland, OH), which includes electronic health record data from 26 major integrated US healthcare systems from 2000 to 2019. Using Systematized Nomenclature of Medicine Clinical Terms, we identified all patients (age >18 years) with UC. The primary outcome was to evaluate the prevalence of UC colectomy and biologic utilization over 2 decades as well as compare these rates with linear regression. We also performed a multi-regression analysis. The biologic group included anti-TNFs, anti-integrin, and anti-IL12,23. Results: Of 61,592,650 patients in the database, we identified 146,430 patients with UC between 2000 and 2019, of whom 15,020 (10.2%) had colectomy and 10,050 (6.8%) patients were treated with biologics, respectively. Over 2 decades, the prevalence of colectomy decreased from 10.8% in 2000 to 2.1% in 2019. This decline was associated with a linear increase in the prevalence of biologic medication utilization in UC from 0.5% in 2000 to 12.8% in 2019, (P< 0.001). After adjusting for other therapies including mesalamine, corticosteroids, and thiopurines, biologics were inversely related to colectomy, P< 0.001, respectively. Meanwhile Mesalamine and colectomy did not have an inverse relation, P< 0.001. Discussion: Colectomy rates have declined over the past 20 years with increased utilization of biologics. This is the largest study utilizing a population-based approach and is consistent with the results of smaller cohort studies that demonstrated declining UC colectomy rates due to biologics.
Figure 1. The trend of colectomy and biologic use prevalence over 2 decades
Figure 2. The linear regression analysis of colectomy and biologic use prevalence over 2 decades
Disclosures: George Khoudari indicated no relevant financial relationships. Emad Mansoor indicated no relevant financial relationships. Ahmed Eltelbany indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Jeffry Katz indicated no relevant financial relationships. Gregory Cooper indicated no relevant financial relationships. Miguel Regueiro: Abbvie – Advisory Committee/Board Member, Consultant, Grant/Research Support. Janssen – Advisory Committee/Board Member, Consultant, Grant/Research Support. Takeda – Advisory Committee/Board Member, Consultant, Grant/Research Support.