OBJECTIVES : Describe the US incidence of moderate-to-severe ulcerative colitis (UC) and assess regional variations in treatment use.

METHODS : Adults (≥18 years) with ≥1 medical claim for UC (index was first UC diagnosis) from 1/01/2016-06/30/2019 were identified from the IQVIA PharMetrics Plus claims database. Eligible patients had 12-month continuous enrollment pre-index and 6 months post-index and did not have a diagnosis of Crohn’s or UC in the baseline period. Moderate-to-severe UC was defined as having a second medical claim for UC and a claim for moderate-to-severe UC treatment (corticosteroids, immunomodulators, biologics, 5-ASA + corticosteroid, tofacitinib) post-index. Medications and treatment characteristics were captured at treatment initiation; demographics and US region were recorded at index. Incidence was defined as newly identified moderate-to-severe UC patients (2016-2019) divided by patients at risk.

RESULTS : Overall moderate-to-severe UC incidence was 25.7 (CI: 25.09-26.24) cases per 100,000. Among 7609 newly diagnosed patients, mean age (±SD) at index was 45 (±14) years; 52% of patients were female, and 75% resided in metropolitan areas. Patients initiated treatment with corticosteroids (67%), 5-ASA+corticosteroids (17%), immunomodulators (9%), biologics (5%), or a combination (1%). Mean time to treatment initiation was 29 (±44) days. Patients in the Northeast and South regions commonly initiated corticosteroids (68%), while a lower proportion of patients initiated immunomodulators in the South vs. the West (8% vs. 13%). Initiation of biologics was consistent across regions (~5%). In metropolitan areas, the use of corticosteroids (69% vs. 67%) was slightly lower, while the use of biologics was higher (5.5% vs. 4.1%) compared with non-metropolitan areas.

CONCLUSIONS : Results provide real-world insights into the current treatment landscape for moderate-to-severe UC. The high use of corticosteroids is congruent with published guidelines; however, use of immunomodulators is not. Variability was observed in treatment use between metropolitan and non-metropolitan areas, highlighting disparity in the management of UC.