OBJECTIVES:

Biologic drugs are increasingly used for treating ulcerative colitis (UC) patients, but the association between drug therapy initiation and patients’ socio-demographic characteristics in real-world clinical practice is scarcely explored. Therefore, we assessed wether socio-demographic characteristics are associated with biologic treatment initiation in a large cohort of UC patients in Israel.

METHODS:

Our cohort included all UC patients diagnosed from 2005 to 2018 and listed in a nationwide UC registry. For each patient we extracted socio-demographic characteristics included age, sex, religion, geographical district, as well as the date of UC diagnosis and biologic drug treatment initiation. We used Kaplan-Meier survival analyses and a series of multivariable Cox-proportional hazards regressions to assess the time from UC diagnosis until initial biologic drug dispensation and ascertain potential effects of socio-demographic factors on the likelihood that UC patients receive biologic drug therapy.

RESULTS:

Of 13,003 UC patients diagnosed during the study period, 1,660 (12.8%) initiated biologic drug therapy. The mean age at diagnosis was 39.6±18.7 years; 6,582 (50.6%) were female. For UC patients diagnosed at the age of 0 to 17, the adjusted hazard ratio (HR) for biologics treatment initiation was 1.41 (95% CI 1.26-1.59), and for patients diagnosed at age 65 and higher, the adjusted hazard ratio was 0.54 (95% CI 0.42-0.69), all compared to patients diagnosed at age 18-64. Sex, religion and geographical district were not associated with the initiation of biologic therapy in UC patients.

CONCLUSIONS:

The initiation of biologic drugs in UC patients was significantly higher in younger patients and significantly lower in elderly, but did not differ by sex, religion or district. The results can probably ascertain the high level of equity in access to biologic drug care for UC patients in Israel.