Work

Bridging the evidence gap in isolated proctitis: real-world evidence on medical therapies for isolated proctitis—a nation-wide analysis using data of 8346 patients from UK IBD BioResource

Year: 2026

Type: article

Abstract: Background: Isolated proctitis (IP) affects a third of patients with ulcerative colitis. The long-term effectiveness of medical therapies in IP is still unclear. Objective: To assess the effectiveness of medical therapies in IP. Design: A retrospective observational cohort study using data from the NIHR IBD BioResource registered between April 4, 2016, and January 3, 2025. Results: A total of 8346 patients with IP were included. The probability of treatment escalation from 5-aminosalicylates (5-ASAs) was 11.1%, 21.5%, and 27.3% at 1, 3, and 5 years respectively. Age onset >40 years was associated with a lower risk (hazard ratio [HR] = 0.552, 95% confidence interval [CI]: 0.491-0.621) and presence of extra-intestinal manifestations (EIMs) associated with a higher risk (HR = 1.701, 95% CI: 1.432-2.020) of treatment escalation. The probability of treatment escalation from thiopurines was 14%, 24.4%, and 30.8% at 1, 3, and 5 years respectively. Montreal classification A3 (HR = 0.707, 95% CI: 0.597-0.836) and longer disease duration (HR = 0.983, 95% CI: 0.972-0.995) were associated with a lower risk, while co-diagnosis of EIM indicated a higher risk (HR = 1.513, 95% CI: 1.209-1.894) of treatment escalation. Compared to infliximab, adalimumab (odds ratio [OR] 0.537, 95% CI: 0.416-0.692) and golimumab (OR 0.361, 95% CI: 0.206-0.618) were associated with reduced odds, while anti-integrin exposure was associated with an increased odds of treatment response (OR 2.033, 95% CI: 1.529-2.720). Conclusion: Among the available advanced therapies evaluated, anti-integrin therapy was associated with the highest treatment persistence and response rates in this real-world cohort of IP. Further clinical trials are warranted in IP.

Source: Crohn s & Colitis 360

DOI: 10.1093/crocol/otag118