Intestinal Research

Original Articles

Escalation to biologics after corticosteroids in patients with newly diagnosed Crohn’s disease in Japan: a claims analysis from 2010 to 2021: Minoru Matsuura, Annabelle Yoon, Jun Miyoshi, Tadakazu Hisamatsu; Received April 17, 2025 Accepted August 18, 2025 Published online November 25, 2025; DOI: https://doi.org/10.5217/ir.2025.00059 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
A previous health insurance claims study of Japanese patients with newly diagnosed Crohn’s disease (CD) reported an increase in “step-up” approach from 2010 to 2020, with biologic use in the first year remaining stable. This study examined systemic corticosteroid (SCS) use for newly diagnosed CD in Japan and compared patients who were escalated (“step-up”) and were not escalated to biologics.
Methods
This retrospective longitudinal cohort study used health insurance claims data (JMDC database). Patients diagnosed with CD from 2010 to 2020 who had no CD-related claims for ≥ 1 year before index, were traceable for ≥ 1 year after index, and treated with ≥ 1 pre-defined treatment were included. Patients classified by SCS and/or biologic use within 1 year after diagnosis were compared.
Results
Of 823 patients, 379 (46.1%) received SCS in the first year; of these, 43.5% escalated to biologics (step-up group) and 56.5% did not (SCS group). The proportion of patients receiving SCS increased from 25.8% in 2010–2011 to 55.5% in 2020; proportion escalated to biologics increased from 33.8% in 2016–2017 to 51.0% in 2020. The step-up group was significantly younger, more likely to have perianal lesions, and received more intensive treatments than the SCS group. In terms of SCS use, the step-up group was more likely to have shorter time-to-SCS initiation, and a higher initial SCS dose, than the SCS group.
Conclusions
Escalation from SCS to biologics in Japanese patients with newly diagnosed CD increased between 2016 and 2020, particularly in patients with younger onset CD or perianal complications.

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IBD

Real-world use of biologics during the first year of treatment for newly diagnosed Crohn’s disease in Japan: a claims analysis from 2010 to 2021: Jun Miyoshi, Annabelle Yoon, Minoru Matsuura, Tadakazu Hisamatsu; Intest Res 2026;24(1):129-140. Published online January 23, 2025; DOI: https://doi.org/10.5217/ir.2024.00082

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Crohn’s disease (CD) leads to bowel damage and disability if suboptimally treated. We investigated firstyear treatment decisions and real-world use of biologics in patients with CD in Japan.
Methods
In this retrospective observational study (2010–2021) from the JMDC claims database, patients with a new diagnosis of CD (no CD claims record within 12 months before index) who received ≥ 1 pre-defined treatment were grouped by use of biologics and systemic corticosteroids (SCS) within the first year of diagnosis.
Results
Of 823 patients included, 470 (57.1%) were prescribed biologics and 353 (42.9%) were not; 77.6% were male, 75.7% had adult-onset CD, and median age was 24 years. Patients prescribed biologics were younger (median: 23 years vs. 28 years) and more had perianal lesions (43.0% vs. 22.9%) than those not prescribed biologics; 64.9% (95% confidence interval, 60.4%–69.2%) received a top-down treatment approach (no SCS before biologics). Factors significantly associated with a top-down treatment approach were male sex, perianal lesions, no use of immunomodulators, and use of anti-tumor necrosis factor therapies. The proportion of patients receiving SCS before biologics (step-up approach) increased after 2018, with a shift from prednisolone to budesonide from 2016. Persistence with first biologics decreased over time, with no differences between biologic types.
Conclusions
Use of biologics for treatment of CD within the first year of diagnosis in Japan has remained stable over the past decade. However, there was a shift to a step-up treatment approach, with an increase in use of SCS before biologics over time.

Citations

Citations to this article as recorded by

Towards an Asian paradigm of inflammatory bowel disease management: A comparative review of China and Japan
Qi Sun, Zhixian Jiang, Lichao Yang, Hao Liu, Peipei Song, Lianwen Yuan
Intractable & Rare Diseases Research.2025; 14(3): 192. CrossRef

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2 Web of Science
1 Crossref

Review

IBD

First aid with color atlas for the use of intestinal ultrasound for inflammatory bowel disease in daily clinical practice: Jun Miyoshi, Hiromu Morikubo, Hiromi Yonezawa, Hideaki Mori, Tadakazu Hisamatsu; Intest Res 2023;21(2):177-188. Published online April 28, 2023; DOI: https://doi.org/10.5217/ir.2023.00003

Abstract PDF PubReader ePub

Intestinal ultrasound (IUS) is a promising modality for the management of inflammatory bowel disease (IBD) and has the potential to particularly contribute in monitoring disease activity, an advantage crucial for optimizing the therapeutic strategy. While many IBD physicians appreciate and are interested in the use of IUS for IBD, currently only a limited number of facilities can employ this examination in daily clinical practice. A lack of guidance is one of the major barriers to introducing this procedure. Standardized protocols and assessment criteria are needed such that IUS for IBD can be considered a feasible, reliable examination in clinical practice, and multicenter clinical studies can be conducted for further clinical evidence of the application of IUS in IBD for best patient care. In this article, we provide an overview of how to start IUS for IBD and introduce basic procedures. Furthermore, IUS images from our practice are provided as a color atlas for understanding sonographic findings and scoring systems. We anticipate this “first aid” article will be helpful to promote IUS for IBD in daily practice.

Citations

Citations to this article as recorded by

Recent Advances in Molecular Targeted Therapy for Inflammatory Bowel Disease
Tadakazu Hisamatsu, Jun Miyoshi, Minoru Matsuura
Internal Medicine.2026; 65(2): 196. CrossRef
Determination of optimal cutoff value of ulcerative colitis intestinal ultrasound index to estimate endoscopic improvement in ulcerative colitis
Haruka Komatsu, Hiromu Morikubo, Yoko Kimura, Chihiro Moue, Hiromi Yonezawa, Minoru Matsuura, Jun Miyoshi, Tadakazu Hisamatsu
Journal of Gastroenterology.2025; 60(2): 166. CrossRef
Bildgebung bei chronisch-entzündlichen Darmerkrankungen
Christoph F. Dietrich, Kathleen Möller
Die Innere Medizin.2025; 66(1): 40. CrossRef
Upadacitinib after tofacitinib in ulcerative colitis
Hyeon Jin Cho, Eun Soo Kim
Intestinal Research.2025; 23(3): 229. CrossRef
Intestinal Ultrasound in Clinical Inflammatory Bowel Disease Care: From Diagnosis to Tight Monitoring
Kwang Woo Kim
Clinical Ultrasound.2025; 10(2): 75. CrossRef
A combination of bowel wall thickness and submucosa index is useful for estimating endoscopic improvement in ulcerative colitis: external validation of the Kyorin Ultrasound Criterion
Haruka Komatsu, Hiromu Morikubo, Yoko Kimura, Chihiro Moue, Hiromi Yonezawa, Minoru Matsuura, Jun Miyoshi, Tadakazu Hisamatsu
Journal of Gastroenterology.2024; 59(3): 209. CrossRef
Early Sonographic Improvement Predicts Clinical Remission and Mucosal Healing With Molecular-Targeted Drugs in Ulcerative Colitis
Yoko Kimura, Jun Miyoshi, Hiromu Morikubo, Haruka Komatsu, Chihiro Moue, Hiromi Yonezawa, Minoru Matsuura, Tadakazu Hisamatsu
Gastro Hep Advances.2024; 3(6): 703. CrossRef
IBD barriers across the continents – East Asia
Joyce Wing Yan Mak, Agnes Hiu Yan Ho, Siew Chien Ng
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef

10,010 View
495 Download
8 Web of Science
8 Crossref

Case Report

IBD

5-Aminosalicylic acid aggravates colitis mimicking exacerbation of ulcerative colitis: Jun Miyoshi, Katsuyoshi Matsuoka, Atsushi Yoshida, Makoto Naganuma, Tadakazu Hisamatsu, Tomoharu Yajima, Nagamu Inoue, Susumu Okamoto, Yasushi Iwao, Haruhiko Ogata, Fumiaki Ueno, Toshifumi Hibi, Takanori Kanai; Intest Res 2018;16(4):635-640. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00015

Abstract PDF PubReader ePub

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.

Citations

Citations to this article as recorded by

Evaluation of drug-induced lymphocyte stimulation test in mesalazine-associated allergic drug reaction
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Journal of Allergy and Clinical Immunology: Global.2026; 5(2): 100625. CrossRef
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Yuka Minoura, Koji Yokoyama, Yuko Okada, Shinya Fukuda, Hideki Kumagai
Pediatrics International.2025;[Epub] CrossRef
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Journal of Clinical Medicine.2025; 14(19): 7019. CrossRef
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Yingying Liu, Ainsley M. Robinson, Xiao Qun Su, Kulmira Nurgali
Biomolecules.2024; 14(4): 447. CrossRef
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Antioxidants.2024; 13(5): 575. CrossRef
Characteristics of Mucosa-Associated Microbiota in Ulcerative Colitis Patients with 5-Aminosalicylic Acid Intolerance
Hiroshi Matsumoto, Momoyo Sasahira, Tei Tei Go, Shogen Yo, Takehiro Ninomiya, Motoyasu Osawa, Osamu Handa, Eiji Umegami, Ryo Inoue, Akiko Shiotani
Biomedicines.2024; 12(9): 2125. CrossRef
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Microbial Pathogenesis.2024; 197: 107053. CrossRef
Risk factors for intolerance of oral 5‐aminosalicylic acid preparations in pediatric ulcerative colitis
Naoki Abe, Naomi Iwata, Ryuhei Yasuoka, Daisuke Nishida, Asami Oohara, Haruna Nakaseko, Shiro Sugiura, Shinji Kawabe
Pediatrics International.2023;[Epub] CrossRef
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Biomolecules.2023; 13(11): 1569. CrossRef

20,158 View
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10 Crossref

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