Long-term disease course of ulcerative colitis in a prospective European population-based inception cohort-an Epi-IBD cohort study.

Background and aims: The Epi-IBD cohort is a population-based inception cohort of patients with inflammatory bowel disease from 22 European centers. The aim was to assess the 10-year disease course of patients with ulcerative colitis (UC) across Europe.

Methods: Patients were followed prospectively from the time of diagnosis in 2010 and 2011, with a uniform collection of data to the end of 2020. Associations between covariates and colectomy, progression to extensive disease, and hospitalization were analyzed separately by multivariable Cox regression analyses in a propensity-score-matched subpopulation to address regional differences.

Results: A total of 873 UC patients were recruited (Eastern Europe: 196 [22.4%], Western Europe: 677 [77.5%]). The 10-year crude rate for the use of advanced therapy was comparable in Eastern (13%) and Western Europe (16%) (P > 0.9), and the median time from diagnosis until initiation of advanced treatment was similar, at 3 years. The need for colectomy remained comparable in Eastern and Western Europe, with a 10-year crude rate of 4% and 6% (Cox: P = 0.6), respectively. Likewise, disease progression to extensive disease (10-year rate: 17%, Cox: P = 0.06) and hospitalization (10-year rate: 23%, Cox: P = 0.2) were comparable across Europe. The use of advanced therapy and the early use of corticosteroids were both associated with an increased risk of colectomy (Cox: both P < 0.05).

Conclusions: While the introduction of advanced therapies for UC has transformed the therapeutic landscape, their impact on colectomy rates, disease progression, and hospitalizations remains modest. Our findings highlight the need for continued innovation in UC treatment and the importance of individualized and targeted care to achieve optimal long-term outcomes.