Paradigm Shift in Inflammatory Bowel Disease Management—Advanced Therapy Utilisation, Persistence, and Outcomes in a United Arab Emirates Cohort During 2015–2025

Abstract Background The therapeutic landscape for inflammatory bowel disease (IBD) has expanded rapidly beyond anti-TNF agents. We characterised the evolution of advanced therapy utilisation, persistence, and outcomes in a United Arab Emirates (UAE) cohort during 2015-2025. Methods This prospective registry study from a tertiary IBD facility in the UAE included 508 patients (333 Crohn’s disease [CD], 175 ulcerative colitis [UC]). Advanced therapies were grouped by mechanism of action. We compared prescribing patterns between 'Pre-2023' and '2023 and Beyond’ eras. Treatment persistence was analysed using Kaplan-Meier methods and Cox proportional hazards models. Results Of 508 patients, 380 (74.8%) received advanced therapy. In CD, first-line anti-TNF use fell from 76% (pre-2023) to 42% (2023+), with anti-IL-23 agents emerging as a major first-line option (32%). Median time to first advanced therapy decreased dramatically: CD from 23.0 to 2.0 months (p < 0.0001) and UC from 37.0 to 3.0 months (p < 0.0001). Anti-IL-23 agents demonstrated significantly superior persistence in CD first-line therapy (p = 0.011 vs anti-TNF). In multivariable analysis, anti-IL-23 therapy was associated with significantly lower discontinuation risk (HR: 0.35, 95% CI: 0.19-0.64, p = 0.0008). Infliximab persistence appeared to improve over time, with significantly better 1-year persistence in 2024+ versus 2018-2019 (pairwise p = 0.020; overall trend p = 0.05). A shift in UC second-line prescribing was also observed (p = 0.048). Early surgery rates were low across both eras (CD: 6.5% vs 3.9%; UC: 2.5% vs 1.9%) with no significant difference in 35-month surgery-free survival, though this analysis was underpowered. Conclusions IBD management in the UAE has undergone a rapid paradigm shift since 2023, characterised by earlier therapy initiation and diversification away from anti-TNF dominance, particularly in CD. Superior persistence of anti-IL-23 agents in our cohort is consistent with this evolution in clinical practice and supports its further evaluation.