OBJECTIVES: Anti-TNF agents (ATAs) are generally the first-line biological therapy in ulcerative colitis (UC) patients who have failed treatment with corticosteroids and/or immunomodulators. Patients with non-response/loss of response with ATAs undergo treatment switch or colectomy/surgery. We assessed the rates of UC-related hospitalization and colectomy among patients on ATAs in real-world UC patients.

METHODS: A systematic literature review was conducted using comprehensive searches in Embase and Medline databases to identify real-world studies published in English during 2005−January 2022. Studies were included if conducted in biological-naïve UC patients who initiated ATAs, had ≥50 patients, and published as full manuscripts. Exclusion criteria were mixed population, <50 patients, conference abstracts and non-English articles.

RESULTS: Of the 2593 records retrieved from literature, 29 were included providing 27 unique studies. These studies were from Europe (number of studies [n]=15), Korea (n=5), Canada (n=3), US, and Japan (n=2 each). The study design was retrospective (n=19) and prospective observational (n=7). Studies had variations in age (median, 26−45 years), gender ratio (male, 46−64%), disease duration (median, 3−8 years), and baseline concomitant medications (steroids, 42−89%; immunomodulators, 13−78%; 5-ASA, 31−97%). Studies assessed at least one of the following ATAs: infliximab-originator (n=18), adalimumab (n=6), golimumab (n=2), infliximab-biosimilar (n=2), and ATAs as group (n=5). The follow-up duration ranged from 10 weeks to 5.8 years. UC-related hospitalization was reported in seven studies, with 7−32% of patients being hospitalized in these studies. All studies reported UC-related colectomy, with rates of colectomy/surgery varied between 0% and 42% of patients. Colectomy rates by individual ATA were 1−42% (infliximab), 0−8% (adalimumab), and 1−8% (golimumab). Four studies comparing infliximab and adalimumab showed no significant difference in colectomy rates.

CONCLUSIONS: This review revealed that a considerable proportion of biologics-naïve UC patients in real-world clinical practice undergo colectomy/surgery while on/after treatment with ATAs, whereas data on UC-related hospitalization is limited in literature.