Abstract Background The optimal sequencing of biologics and Janus kinase inhibitors (JAKi) in ulcerative colitis (UC) remains unclear. We compared the treatment durability of two therapeutic strategies using a nationwide claims database: anti-tumor necrosis factor (TNF)-α agents to JAKi (A→J) versus JAKi to anti–TNF-α agents (J→A). Methods We conducted a retrospective cohort study using the Korean Health Insurance Review and Assessment (HIRA) database. Adult patients with UC who initiated anti-TNF-α agents or JAKi as a first-line treatment between 2010 and 2023 were identified. The primary outcome was durability of the second-line therapy, defined as time from its initiation to discontinuation. Propensity score matching was applied to balance baseline characteristics between groups, and multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHR) for treatment discontinuation. Results A total of 314 patients were included (A→J, n = 273; J→A, n = 41). J→A group was younger (median 33.0 vs 42.0 years; P = 0.02), while concomitant usages of corticosteroids at index date were significantly higher in A→J (65.57% vs 36.59%, P 0.01) (Table 1). Both first- and second-line treatment durations were significantly longer in the A→J group (first-line, 10.50 vs 6.27 months, P = 0.03; second-line, 25.17 vs 11.17 months, P 0.01) (Table 1). After matching for age, sex, comorbidities, steroid use at the index date, and first-line treatment duration, Kaplan–Meier analysis showed greater second-line durability in the A→J group compared with the J→A group (aHR 2.48; 95% CI 1.18–5.21; P = 0.02) (Figure 1). However, durability of the first-line treatment was no longer statistically significant after matching (P = 0.46). Correlations between first- and second-line treatment durations were also not statistically significant in either group (A→J, P = 0.95; J→A, P = 0.06). Conclusion In Korean patients with UC, switching from anti–TNF-α agents to JAK inhibitors was associated with significantly longer treatment durability compared with the reverse sequence. These findings highlight the importance of sequencing when aiming to optimize long-term UC management. Conflict of interest: Dr. Baek, Ji Eun: No conflict of interest KIM, Sol: No conflict of interest Choi, Arum: No conflict of interest Lee, Han Hee: No conflict of interest Lee, Bo-In: No conflict of interest Lee, Kang-Moon: No conflict of interest
Baek et al. (Thu,) studied this question.