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

Alexander T Elford; Nathan Constantine-Cooke; Phil W Jenkinson; Beatriz Gros; Nikolas Plevris; Mathew Lyons; Solomon Ong; Neil Greenlees; Victor Velasco-Pardo; Claire O'Hare; Nicholas T Ventham; Paul Henderson; David C Wilson; Shahida Din; Colin L Noble; Gareth-Rhys Jones; Ian Arnott; Charlie W Lees

doi:10.1111/apt.70240

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

Aliment Pharmacol Ther. 2025 Jun 16. doi: 10.1111/apt.70240. Online ahead of print.

Authors

Alexander T Elford^{1

2}, Nathan Constantine-Cooke^{3

4}, Phil W Jenkinson¹, Beatriz Gros^{1

5

6}, Nikolas Plevris¹, Mathew Lyons⁷, Solomon Ong¹, Neil Greenlees¹, Victor Velasco-Pardo⁴, Claire O'Hare¹, Nicholas T Ventham¹, Paul Henderson^{8

9}, David C Wilson^{8

9}, Shahida Din^{1

10}, Colin L Noble¹, Gareth-Rhys Jones¹, Ian Arnott¹, Charlie W Lees^{1

4}

Affiliations

¹ Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
² Faculty of Medicine, The University of Melbourne, Melbourne, Australia.
³ MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK.
⁴ Centre for Genomics and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK.
⁵ Department of Gastroenterology and Hepatology, Reina Sofía University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain.
⁶ Biomedical Research Center in Hepatic and Digestive Disease, CIBEREHD, Madrid, Spain.
⁷ Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
⁸ Royal Hospital for Children and Young People, Edinburgh, UK.
⁹ Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
¹⁰ Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.

PMID: 40521877
DOI: 10.1111/apt.70240

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.

Abstract

Grants and funding