Persistence of advanced therapies in patients with ulcerative colitis: real-world data from the nationwide CREdIT registry

Background: The expanding therapeutic landscape of ulcerative colitis (UC) introduces uncertainty regarding the optimal positioning of new agents. Objectives: This study aimed to compare the real-world persistence of advanced therapies for UC. Design: This observational cohort study used a population-based national registry of biologic and small-molecule therapies for inflammatory bowel disease, CREdIT, to identify patients treated with advanced therapy for UC. Methods: The primary outcome was treatment persistence – defined as time from therapy initiation to discontinuation or last follow-up, whichever occurred first – and was analysed using mixed-effects Cox models and inverse probability weighting. Persistence was assessed overall, in first-line therapy, and in second-line therapy after adalimumab or infliximab exposure. Results: We included 3718 observations from 2525 patients with UC (48% female). Infliximab (40%), vedolizumab (27%) and adalimumab (17%) were most frequently used. At 5 years, 1852 of 3718 observations (49.8%) remained on the same therapy. The treatment line alone was not associated with treatment persistence after accounting for patient-level clustering using a mixed-effects model. Vedolizumab showed significantly greater persistence than infliximab or adalimumab, including in first-line use. In second-line settings post-anti-tumour necrosis factor (TNF) exposure, upadacitinib had the highest persistence compared to tofacitinib, vedolizumab and ustekinumab, whereas vedolizumab was more persistent than tofacitinib. Conclusion: Vedolizumab demonstrated longer persistence than infliximab or adalimumab, regardless of treatment line. Following anti-TNF failure, upadacitinib showed the highest persistence.