Crohn's & colitis 360 · 2026
Paradigm shift in inflammatory bowel disease management-advanced therapy utilization, persistence, and outcomes in a United Arab Emirates cohort during 2015-2025.
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Abdelrahman Ahmed Hosameldin, Alzaabi Mohamed Nasir, Swaid Thaer Khaleel, Khan Shaima Wasim, Al Hosani Maitha, Al Hosani Noorah, Alahmad Maryam A, Omar Nadeen Mamon, Ahmed Enas Fouad, Ahmed Ishtiaq, Kumar Kishore Kumar Chitra, Bukasa Laurette L, Jess Tine, Quraishi Mohammed Nabil
Аннотация
BACKGROUND: The therapeutic landscape for inflammatory bowel disease (IBD) has expanded rapidly beyond anti-tumor necrosis factor (anti-TNF) agents. We characterized the evolution of advanced therapy utilization, 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 analyzed 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 < .0001) and UC from 37.0 to 3.0 months (P < .0001). Anti-IL-23 agents demonstrated significantly superior persistence in CD first-line therapy (P = .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 = .0008). Infliximab persistence appeared to improve over time, with significantly better 1-year persistence in 2024+ versus 2018-2019 (pairwise P = .020; overall trend P = .05). A shift in UC second-line prescribing was also observed (P = .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, characterized 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 their further evaluation.
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 analyzed 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 < .0001) and UC from 37.0 to 3.0 months (P < .0001). Anti-IL-23 agents demonstrated significantly superior persistence in CD first-line therapy (P = .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 = .0008). Infliximab persistence appeared to improve over time, with significantly better 1-year persistence in 2024+ versus 2018-2019 (pairwise P = .020; overall trend P = .05). A shift in UC second-line prescribing was also observed (P = .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, characterized 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 their further evaluation.