Ten-Year Trend in 5-Aminosalicylic Acid Prescription Patterns and Treatment Outcomes in Patients with Ulcerative Colitis: An Analysis of Korean Health Insurance Data

Abstract

Background While the prevalence of ulcerative colitis (UC) is continuously increasing in Asia, published data related to the real-world use of 5-aminosalicylic acid (5-ASA) for this population are sparse. Methods Using Korean national health insurance claims data between 2008 and 2019, distributions of the average daily dose of 5-ASA and mode of administration in the population with UC were analyzed. Treatment outcomes were evaluated through proportions of patients with insufficient response (other treatments added to or switched from 5-ASA), hospitalization, or surgery. Results The analysis included data from 11,338 patients (mean age, 42.15 years; 59.53% male). During a median observation period of 1720 days, a tendency to decrease in rectal monotherapy proportion was observed, along with an increase in the proportion of oral and rectal combination therapies. The odds of prescribing standard-to-high dose 5-ASA (>= 2g/day) increased significantly since 2013 (P < 0.05). The proportion of oral and rectal combination therapies with standard-to-high doses of 5-ASA increased from 18.09% in 2009 to 36.23% in 2017, whereas the proportions of oral monotherapy and oral and rectal combination therapies with low doses of 5-ASA decreased from 17.46% to 7.74% and from 11.64% to 8.98%, respectively. The incidence rates/1000 person-years for insufficient responses, UC-related hospitalizations, and UC-related surgery were 51.16, 13.40, and 1.13, respectively. Conclusion During the 10-year period, the 5-ASA prescription pattern shifted towards more frequent use of high-dose 5-ASA as a combination therapy, accompanied by a decrease in the frequency of rectal monotherapy prescriptions, which is consistent with current guidelines.