Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland

Alexander T Elford; Nathan Constantine-Cooke; Philip W Jenkinson; Beatriz Gros; Nikolas  Plevris; Mathew Lyons; Solomon Ong; Neil Greenlees; Victor Velasco Pardo; Nicholas Ventham; Paul Henderson; David C Wilson; Shahida Din; Colin L Noble; Gareth-Rhys Jones; Ian  Arnott; Charlie W Lees

doi:10.1111/apt.70240

Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland

Alexander T Elford, Nathan Constantine-Cooke, Philip W Jenkinson, Beatriz Gros, Nikolas Plevris, Mathew Lyons, Solomon Ong, Neil Greenlees, Victor Velasco Pardo, Nicholas Ventham, Paul Henderson, David C Wilson, Shahida Din, Colin L Noble, Gareth-Rhys Jones, Ian Arnott, Charlie W Lees^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with con-flicting published evidence.

Aim: To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023.
Methods: We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise
linear regression analyses to identify temporal trends in prescription and colectomy rates.

Results: The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line
advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates.

Conclusion: The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.

Original language	English
Pages (from-to)	699-709
Journal	Alimentary Pharmacology and Therapeutics
Volume	62
Issue number	7
Early online date	16 Jun 2025
DOIs	https://doi.org/10.1111/apt.70240
Publication status	Published - Oct 2025

Keywords / Materials (for Non-textual outputs)

advanced therapies
biologics
colectomy
inflammatory bowel disease
ulcerative colitis

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10.1111/apt.70240Licence: Creative Commons: Attribution (CC-BY)

Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland_finalFinal published version, 4 MBLicence: Creative Commons: Attribution (CC-BY)

Decoding macrophage functional heterogeneity in the pathogenesis of Crohn's disease
Jones, G. (Principal Investigator) & Ho, G.-T. (Co-investigator)
Wellcome Trust (Rcl)
1/04/21 → 31/03/25
Project: Research

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Elford, A. T., Constantine-Cooke, N., Jenkinson, P. W., Gros, B., Plevris, N., Lyons, M., Ong, S., Greenlees, N., Velasco Pardo, V., Ventham, N., Henderson, P., Wilson, D. C., Din, S., Noble, C. L., Jones, G.-R., Arnott, I., & Lees, C. W. (2025). Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland. Alimentary Pharmacology and Therapeutics, 62(7), 699-709. https://doi.org/10.1111/apt.70240

@article{8746d7ff2e874e568059ada086f4dd87,

title = "Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland",

abstract = "Background: The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with con-flicting published evidence. Aim: To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023. Methods: We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise linear regression analyses to identify temporal trends in prescription and colectomy rates. Results: The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68\% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates. Conclusion: The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.",

keywords = "advanced therapies, biologics, colectomy, inflammatory bowel disease, ulcerative colitis",

author = "Elford, \{Alexander T\} and Nathan Constantine-Cooke and Jenkinson, \{Philip W\} and Beatriz Gros and Nikolas Plevris and Mathew Lyons and Solomon Ong and Neil Greenlees and \{Velasco Pardo\}, Victor and Nicholas Ventham and Paul Henderson and Wilson, \{David C\} and Shahida Din and Noble, \{Colin L\} and Gareth-Rhys Jones and Ian Arnott and Lees, \{Charlie W\}",

note = "This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.",

year = "2025",

month = oct,

doi = "10.1111/apt.70240",

language = "English",

volume = "62",

pages = "699--709",

journal = "Alimentary Pharmacology and Therapeutics",

issn = "0269-2813",

publisher = "Wiley",

number = "7",

}

Elford, AT, Constantine-Cooke, N, Jenkinson, PW, Gros, B, Plevris, N, Lyons, M, Ong, S, Greenlees, N, Velasco Pardo, V, Ventham, N, Henderson, P , Wilson, DC , Din, S, Noble, CL, Jones, G-R, Arnott, I & Lees, CW 2025, 'Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland', Alimentary Pharmacology and Therapeutics, vol. 62, no. 7, pp. 699-709. https://doi.org/10.1111/apt.70240

TY - JOUR

T1 - Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland

AU - Elford, Alexander T

AU - Constantine-Cooke, Nathan

AU - Jenkinson, Philip W

AU - Gros, Beatriz

AU - Plevris, Nikolas

AU - Lyons, Mathew

AU - Ong, Solomon

AU - Greenlees, Neil

AU - Velasco Pardo, Victor

AU - Ventham, Nicholas

AU - Henderson, Paul

AU - Wilson, David C

AU - Din, Shahida

AU - Noble, Colin L

AU - Jones, Gareth-Rhys

AU - Arnott, Ian

AU - Lees, Charlie W

N1 - This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

PY - 2025/10

Y1 - 2025/10

N2 - Background: The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with con-flicting published evidence. Aim: To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023. Methods: We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise linear regression analyses to identify temporal trends in prescription and colectomy rates. Results: The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates. Conclusion: The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.

AB - Background: The impact of advanced therapy prescribing on colectomy rates in ulcerative colitis (UC) is unknown with con-flicting published evidence. Aim: To describe advanced therapy prescribing trends and colectomy rates for patients with UC in Lothian, UK between January 1st, 2004 and December 31st, 2023. Methods: We obtained incidence and prevalence data from the Lothian IBD Registry, a rigorously validated population cohort. We report advanced therapy prescribing and colectomy data as raw numbers and annual incidence rates. We used piecewise linear regression analyses to identify temporal trends in prescription and colectomy rates. Results: The prevalence of UC increased from 216 to 441 per 100,000 population in the 20 years from 2004, culminating in a total of 4115 patients with UC in 2023. We identified 720 patients who had received an advanced therapy. Prescribing of first-line advanced therapy increased from 0 in 2004 to 115 in 2023, equating to 0.00 and 2.82 per 100 patients with UC. We identified 563 patients of the prevalent UC population who had colectomy, of whom 68% were performed as emergencies. Absolute colectomy numbers decreased from 42 in 2004 to 7 in 2023, equating to 2.48 and 0.22 per 100 patients with UC. A join point in 2013 was found for both increased advanced therapy prescribing and decreased colectomy rates. Conclusion: The incidence of colectomy in the UC population has decreased over time while the use of advanced therapies has greatly increased.

KW - advanced therapies

KW - biologics

KW - colectomy

KW - inflammatory bowel disease

KW - ulcerative colitis

U2 - 10.1111/apt.70240

DO - 10.1111/apt.70240

M3 - Article

C2 - 40521877

SN - 0269-2813

VL - 62

SP - 699

EP - 709

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

IS - 7

ER -

Twenty-year trends in colectomy rates and advanced therapy prescribing in Lothian, Scotland

Abstract

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Decoding macrophage functional heterogeneity in the pathogenesis of Crohn's disease

Cite this