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. 2025 Oct;62(7):699-709.
doi: 10.1111/apt.70240. Epub 2025 Jun 16.

Twenty-Year Trends in Colectomy Rates and Advanced Therapy Prescribing in Lothian, Scotland

Alexander T Elford  1   2 , Nathan Constantine-Cooke  3   4 , Phil W Jenkinson  1 , Beatriz Gros  1   5   6 , Nikolas Plevris  1 , Mathew Lyons  7 , Solomon Ong  1 , Neil Greenlees  1 , Victor Velasco-Pardo  4 , Claire O'Hare  1 , Nicholas T Ventham  1 , Paul Henderson  8   9 , David C Wilson  8   9 , Shahida Din  1   10 , Colin L Noble  1 , Gareth-Rhys Jones  1 , Ian Arnott  1 , Charlie W Lees  1   4
Affiliations

Twenty-Year Trends in Colectomy Rates and Advanced Therapy Prescribing in Lothian, Scotland

Alexander T Elford et al. Aliment Pharmacol Ther. 2025 Oct.

Abstract

Background: The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with conflicting published evidence.

Aim: To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023.

Methods: We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise linear regression analyses to identify temporal trends in prescription and colectomy rates.

Results: The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates.

Conclusion: The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.

Keywords: advanced therapies; biologics; colectomy; inflammatory bowel disease; ulcerative colitis.

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Figures

FIGURE 1
FIGURE 1
Total number of new advanced therapy prescriptions in the Lothian UC population stratified by year. Number of patients per group; first‐line therapies = 720, second‐line therapies = 297 (41%), third‐line therapies = 130 (18%) and fourth‐line therapies = 59 (8%). A total of 25 patients (3%) had more than four lines of advanced therapies.
FIGURE 2
FIGURE 2
Total number of first advanced therapies prescribed per year in the Lothian UC population stratified by time from 2004 to 2023. A total of 716 first advanced therapies were prescribed across the study period. Piecewise linear regression produced a breakpoint at the beginning of 2013 for first advanced therapy prescriptions and an average annual percent change of 5.47 (95% CI: 4.83, 6.11).
FIGURE 3
FIGURE 3
Sankey diagram demonstrating treatment progression from first‐line therapy through to subsequent lines of therapy in the Lothian UC population.
FIGURE 4
FIGURE 4
Kaplan–Meier curve demonstrating first‐line treatment persistence amongst patients who commenced an advanced therapy for UC in Lothian.
FIGURE 5
FIGURE 5
Total number of colectomies per year in the Lothian UC population stratified by time from 2004 to 2023. A total of 563 colectomies were performed across the study period. Piecewise linear regression produced a breakpoint mid 2013 for colectomies and an average annual percent change of −1.59 (95% CI: −2.05, −1.13) was observed.
FIGURE 6
FIGURE 6
Total numbers of elective and emergency colectomies in the Lothian UC population stratified per year. Emergency colectomy = 359 (68%, 359/527). Elective colectomy = 168 (32%, 168/527). Urgency of operation data unavailable for 36 patients. Piecewise linear regression produced a breakpoint in 2005 for emergency colectomies (APC of 0.14, 95% CI of [−0.26, 0.55]) and 2010 for elective colectomies (APC of −0.18 95% CI of [−0.46, 0.11]).
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References

    1. Gros B. and Kaplan G. G., “Ulcerative Colitis in Adults: A Review,” JAMA 330, no. 10 (2023): 951–965, 10.1001/jama.2023.15389. - DOI - PubMed
    1. Raine T., Bonovas S., Burisch J., et al., “ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment,” Journal of Crohn's & Colitis 16, no. 1 (2022): 2–17, 10.1093/ecco-jcc/jjab178. - DOI - PubMed
    1. Langholz E., Munkholm P., Davidsen M., and Binder V., “Course of Ulcerative Colitis: Analysis of Changes in Disease Activity Over Years,” Gastroenterology 107, no. 1 (1994): 3–11, 10.1016/0016-5085(94)90054-x. - DOI - PubMed
    1. Leijonmarck C. E., “Surgical Treatment of Ulcerative Colitis in Stockholm County,” Acta Chirurgica Scandinavica. Supplementum 554 (1990): 1–56. - PubMed
    1. Worley G., Almoudaris A., Bassett P., et al., “Colectomy Rates for Ulcerative Colitis in England 2003‐2016,” Alimentary Pharmacology & Therapeutics 53, no. 4 (2021): 484–498, 10.1111/apt.16202. - DOI - PubMed

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