Treatment of new-onset ulcerative colitis and ulcerative proctitis: a retrospective study

Summary Background Although guidelines recommend use of oral 5‐aminosalicylates (5‐ASAs) as first‐line therapy in patients with mild to moderate ulcerative colitis (UC) and ulcerative proctitis (UP) and steroids with or without 5‐ASAs in those more severely ill, little is known about how UC and UP are actually treated. Aim To document treatment of new‐onset UC and UP in routine clinical practice. Methods Using a large US health insurance database, we identified all persons with new‐onset UC or UP between 1 January 2005 and 31 December 2007, based on: (i) initial receipt of an oral 5–ASA, mesalazine (mesalamine) suppository, 5‐ASA enema, steroid, antimetabolite, budesonide or TNF inhibitor; (ii) sigmoidoscopy/colonoscopy in prior 30 days resulting in a new diagnosis of UC or UP and (iii) no prior encounters for Crohn's disease. We examined patterns of pharmacotherapy over 1 year. Results We identified 1516 UC patients and 636 UP patients who met study entry criteria. In UC, initial therapies most frequently used were oral 5‐ASAs (53% of patients), oral 5‐ASAs and systemic steroids (12%), systemic steroids (8%) and mesalazine suppositories (6%); in UP, mesalazine suppositories (42%) and oral 5‐ASAs (19%) were most often used, followed by combination therapy (14%), mesalazine enema (11%) and rectal steroids (10%). Few patients received maintenance therapy, and there was limited use of antimetabolites and biological agents. Conclusions Oral 5‐ASAs and systemic steroids are the mainstay of treatment in patients with new‐onset ulcerative colitis; in those with new‐onset ulcerative proctitis, it is mesalazine suppositories. Care of these patients appears consistent with treatment guidelines.