Intestinal Research

Original Articles

IBD

Clinical characteristics of patients with difficult-to-treat ulcerative colitis: a nested case-control study using a Japanese claims database: Katsuyoshi Matsuoka, Ataru Igarashi, Noriko Sato, Naomi Mizuno, Manabu Ishii, Masato Iizuka, Katsuhiko Iwasaki, Ayako Shoji, Tadakazu Hisamatsu; Intest Res 2026;24(1):103-116. Published online April 25, 2025; DOI: https://doi.org/10.5217/ir.2024.00119

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Background/Aims
Despite the advent of advanced therapies, cases of so-called “difficult-to-treat” (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC.
Methods
We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy.
Results
Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC.
Conclusions
The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

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Extraintestinal Manifestations and Cytomegalovirus Reactivation Are Predictors of Difficult-To-Treat in Ulcerative Colitis
Kotaro Akita, Mayuko Erata, Yoshihiro Yokoyama, Yuta Shimomori, Tomoe Kazama, Hiroki Kurumi, Masanori Nojima, Hiroshi Nakase
Inflammatory Intestinal Diseases.2025; 11(1): 18. CrossRef

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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

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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

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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
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