S2030 Demographics and Clinical Characteristics of Patients With Ulcerative Colitis Receiving First-Line Advanced Therapies Categorized in AGA Guidelines as Lower, Intermediate, and Higher Efficacy

Introduction: Advanced therapies (AT) are indicated in patients with moderately-to-severely active ulcerative colitis (UC); however, prescribing patterns vary based on prescriber experience and patient preference. The 2024 American Gastroenterological Association (AGA) guidelines stratify first-line AT in adult patients with UC by lower, intermediate, and higher efficacy.1 We aimed to describe how the demographic and clinical characteristics of adult patients with UC who initiate AT in the USA vary by efficacy classification. Methods: This study used claims data from IQVIA PharMetrics Plus and Optum Insights Clinformatics® Data Mart databases between January 1, 2018 and December 31, 2022, and January 1, 2018 and September 30, 2024, respectively. Patients with UC with ≥ 1 claim for a first-line AT and aged ≥18 years old at AT initiation were included. Patients were categorized into the higher (etrasimod, infliximab, ozanimod, upadacitinib, and vedolizumab), intermediate (golimumab, mirikizumab, tofacitinib, and ustekinumab), and lower (adalimumab) efficacy groups. Not all medications were identified owing to approval dates for UC and data periods. Characteristics were compared between groups using independent sample t-tests or Fisher exact tests. Results: In total, 3,833 and 2,719 patients were included from the IQVIA and Optum databases, respectively, with a substantial proportion of patients in the lower efficacy group (lower: 34.9% and 23.8%; intermediate: 8.8% and 12.3%; higher: 56.4% and 64.0%). Within the higher efficacy group in IQVIA and Optum databases, respectively, 59.5% and 61.7% received vedolizumab, 39.7% and 34.8% received infliximab, and < 1% and 3.5% received other treatments. Age was significantly associated with higher vs lower efficacy groups and, notably, the proportion of patients aged ≥65 years was higher in the higher vs lower efficacy groups for both IQVIA (6.7% vs 4.0%) and Optum (40.1% vs 17.2%). In both databases, patients in the higher efficacy group had significantly higher UC severity scores than the intermediate and lower efficacy groups (P ≤ 0.001 for all). Conclusion: These data show that higher efficacy, first-line AT in UC is associated with greater age and UC severity. Yet, a substantial proportion of patients with UC receive lower efficacy first-line AT, indicating that prescribing patterns may not align with evidence-based recommendations. Reference 1. Singh, S et al. Gastroenterol. 2024;167(7):1307-43.