Choi HI, Moon JR, Lee SH, Cha JM. Advanced therapies in patients with inflammatory bowel disease: A nationwide population-based cohort study. World J Gastroenterol 2026; 32(44): 121290 [DOI: 10.3748/wjg.121290]
Corresponding Author of This Article
Jae Myung Cha, MD, Doctor, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. drcha@khu.ac.kr
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Gastroenterology & Hepatology
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research-article
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Choi HI, Moon JR, Lee SH, Cha JM. Advanced therapies in patients with inflammatory bowel disease: A nationwide population-based cohort study. World J Gastroenterol 2026; 32(44): 121290 [DOI: 10.3748/wjg.121290]
World J Gastroenterol. Nov 28, 2026; 32(44): 121290 Published online Nov 28, 2026. doi: 10.3748/wjg.121290
Advanced therapies in patients with inflammatory bowel disease: A nationwide population-based cohort study
Hyoung Il Choi, Jung Rock Moon, Sun Hwa Lee, Jae Myung Cha
Hyoung Il Choi, Jung Rock Moon, Jae Myung Cha, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, South Korea
Sun Hwa Lee, Department of Biostatistics, Samsung Medical Center, Seoul 06351, South Korea
Author contributions: Cha JM conceived and design the research plan ideas; Choi HI, Moon JR, Lee SH, and Cha JM performed data acquisition and interpretation of the study; Lee SH and Cha JM analyzed the statistical data of the study; Choi HI and Cha JM drafted and revised the manuscript; all the authors approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using ChatGPT to check specific English expressions for language refinement and proofreading. AI tools were not used to generate original scientific data, perform independent analyses, or draw scientific conclusions. The authors carefully review and verified all AI-assisted outputs and take full responsibility for the integrity and scientific content of the manuscript.
Supported by BongHwa Scholarship Foundation to the Korean Association for the Study of Intestinal Diseases for 2024.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Kyung Hee University Hospital in Gangdong (KHNMC IRB No. 2024-05-011).
Informed consent statement: Because all patient data in the Health Insurance Review and Assessment claims database are anonymized, informed consent was not required.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data reported in this study are available from the corresponding author upon reasonable request.
Corresponding author: Jae Myung Cha, MD, Doctor, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. drcha@khu.ac.kr
Received: March 23, 2026 Revised: June 12, 2026 Accepted: July 2, 2026 Published online: November 28, 2026 Processing time: 193 Days and 19.4 Hours
Abstract
BACKGROUND
Patients with inflammatory bowel disease (IBD) often require the sequential use of advanced therapies (ATs) with different mechanism of action. However, real-world data on treatment sequencing, persistence, and treatment pathways of ATs in patients with IBD remain limited.
AIM
To better understand the treatment sequence, persistence, and treatment pathways of ATs in Korean patients with IBD.
METHODS
We performed a nationwide, population-based study of patients newly diagnosed with IBD between 2010 and 2022, after excluding prevalent cases between 2010 and 2011. Among patients who initiated ATs, time to initiation, treatment pathways from first- to fourth-line therapy, and persistence of first-line ATs were analyzed and compared between patients with Crohn’s disease (CD) and ulcerative colitis (UC).
RESULTS
Among patients receiving ATs (CD: n = 6758; UC: n = 4447), anti-tumor necrosis factor therapy was initiated more frequently in patients with CD than in those with UC (40.7% vs 11.2%; P < 0.0001). Infliximab was the most commonly used first-line agent (n = 6885), with greater use in CD than in UC (65.1% vs 55.9%), whereas vedolizumab was more frequently used in UC (13.4% vs 2.5%) and ustekinumab in CD (9.5% vs 3.6%) (all P < 0.0001). The median time to initiating first-line therapy was shorter in patients with CD compared with those with UC. Persistence on infliximab (1037 days vs 516 days), adalimumab (1135 days vs 698 days), ustekinumab (458 days vs 56 days) (all P < 0.0001), and vedolizumab (359 days vs 281 days; P = 0.0057) was longer in patients with CD than in those with UC.
CONCLUSION
The treatment patterns of ATs for IBD differed substantially between CD and UC. These findings highlight the distinct real-world treatment sequencing and durability between IBD subtypes and underscore the need for optimized, disease-specific therapeutic strategies.
Core Tip: This nationwide Korean study demonstrates that advanced therapy use for inflammatory bowel disease shows distinct patterns between Crohn’s disease and ulcerative colitis. Anti-tumor necrosis factor agents, particularly infliximab, are the most common first-line treatments, with earlier initiation and longer persistence in Crohn’s disease. In contrast, vedolizumab is more frequently used for ulcerative colitis, and ustekinumab more commonly used for Crohn’s disease. Overall, treatment sequencing and durability differed significantly according to disease subtype, highlighting the importance of tailored, disease-specific therapeutic strategies in real-world clinical practice.
