Comparative Effectiveness of Advanced Therapies in Advanced-Therapy–Naïve Ulcerative Proctitis: A Multicenter Real-World Cohort Study

Presenter: Khazaaleh S.

This multicentre retrospective study evaluated real-world outcomes with first-line advanced therapies in patients with ulcerative proctitis who were naïve to advanced treatment. The analysis included 1,942 patients from a U.S. electronic health record network treated with Janus kinase inhibitors (upadacitinib or tofacitinib), vedolizumab, infliximab, risankizumab, or sphingosine-1-phosphate modulators (ozanimod or etrasimod). At 12 months, corticosteroid-free remission rates were highest with Janus kinase inhibitors (58%), followed by risankizumab (54%), vedolizumab (51%), infliximab (49%), and sphingosine-1-phosphate modulators (46%). Compared with upadacitinib, adjusted odds ratios for corticosteroid-free remission were 0.87 for vedolizumab, 0.79 for infliximab, 0.93 for risankizumab, and 0.68 for sphingosine-1-phosphate modulators.

Emergency department visits and hospitalizations were lowest with upadacitinib and risankizumab. Treatment discontinuation or switching occurred in 18% of Janus kinase inhibitor users compared with 23% for vedolizumab, 25% for infliximab, 20% for risankizumab, and 28% for sphingosine-1-phosphate modulators. No new safety signals were identified.

All advanced therapies achieved meaningful remission, but JAK inhibitors provided the highest corticosteroid-free remission and lowest discontinuation rates, suggesting they may be preferred as first-line options in advanced-therapy–naïve ulcerative proctitis.

DDW 2026, May 2-5, Chicago, IL