Abstract
Patients with medically refractory ulcerative colitis who previously would have undergone surgery can now elect for subsequent medical therapy. In a commercially insured population, we evaluated the proportion of patients initiating second-line, third-line, or fourth-line treatment who underwent colectomy in the following 12 months. Among 3,325 patients with ulcerative colitis, the colectomy rate within 12 months of a switch in therapy increased from 12% with the first switch to 17% and 19% with the second and third switches, respectively ( P < 0.001). Treatment effectiveness declines with successive switching; however, even after initiating fourth-line therapy, most patients remain surgery-free.
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