OBJECTIVES: Real-world data are increasingly utilized to inform policy and treatment guidelines to optimize the management of ulcerative colitis (UC), an inflammatory bowel disease with varying severity and progression. Current treatment guidelines include a range of options when conventional treatments prove insufficient, such as tumor necrosis factor (TNF) inhibitors (e.g., infliximab), Janus kinase (JAK) inhibitors (e.g., tofacitinib), and other biologics (e.g., vedolizumab). Given the many options available for treating UC, this study aimed to characterize real-world patterns of non-conventional treatments and costs of UC in Sweden over time.

METHODS: This was a retrospective cohort study in Sweden. Patients with a UC diagnosis (ICD-10 code: K51) recorded in the Swedish National Patient Registry after January 1, 2000, were included. Individual-level drug dispensation data were acquired from the Swedish Prescribed Drug Registry between July 2005 and April 2024. Treatment costs were calculated for TNF inhibitors, JAK inhibitors, and other biologics, considering initiation and maintenance costs. List prices were collected from the Swedish Dental and Pharmaceutical Benefits Agency. Descriptive statistics were used to report treatment patterns and costs.

RESULTS: In this cohort study, 10,701 patients with non-conventional UC treatments were included. The most common non-conventional first-line choice was adalimumab (79.1%), followed by vedolizumab (7.8%). Among patients starting treatment before 2022, which marks the update in treatment recommendations in Sweden, 5.0% received vedolizumab compared to 13.4% among those starting treatment after 2022. Mean treatment costs were 5,134 EUR per patient-year. Costs increased over time, reaching up to 7,238 EUR per patient-year for those starting treatment in 2022, a substantial increase compared to those starting treatment before 2022 (4,973 EUR).

CONCLUSIONS: This study demonstrates that adalimumab and vedolizumab were the predominant non-conventional first-line therapies, with increasing use of vedolizumab over time. Mean drug costs of non-conventional treatments have significantly increased, indicating a need for optimization.