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Research Article: Real-world patterns of inflammatory bowel disease treatment across adult and pediatric populations: a nationwide cohort study in South Korea

Date Published: 2026-07-15

Abstract:
Although understanding real-world treatment patterns for inflammatory bowel disease (IBD) from initial diagnosis across age groups is essential, most studies focus on adult populations and advanced therapies. We conducted a descriptive study using a national healthcare database. Patients newly diagnosed with IBD between January 2014, and December 2022 were identified and classified into two groups by disease subtype: ulcerative colitis (UC) or Crohn's disease (CD). They were further stratified by age at the index date (pediatrics: <19 years, adults: ?19 years). Then we examined patients' characteristics and overall treatment patterns. A total of 60,181 individuals were identified as IBD patients with related medication use. Primarily, a younger age at diagnosis was observed among patients with CD, contributing to the predominance of CD within the pediatric population (proportion of CD patients: 71.6% in pediatrics and 24.8% in adults). Furthermore, pediatric-onset IBD was marked by a substantial burden of comorbidities (proportion of patients with ?2 pediatric comorbidity index score: 41.7% in UC and 46.4% in CD) and a tendency toward earlier use of advanced therapies [median time to advanced treatment initiation, months (IQR): pediatrics vs. adults; 8.1 (2.7–18.9) vs. 16.9 (6.0–36.5) in UC; 4.2 (1.6–11.6) vs. 9.6 (3.0–27.3) in CD]. Secondarily, among restricted adult population with at least 1 year follow-up since first advanced agent prescription, cumulative persistence at 12 months was 76.9%?88.5% across the most recently approved agents (vedolizumab and ustekinumab). This study provides a comprehensive nationwide evaluation of patient characteristics and treatment patterns in adult and pediatric IBD patients in South Korea. These findings underscore the importance of tailoring treatment strategies according to disease subtype and age at diagnosis. Given that only tumor necrosis factor (TNF)-alpha inhibitors are currently approved for pediatric use and considering the emerging evidence regarding treatment persistence with newer agents, these findings may support consideration of expanding therapeutic options for pediatric patients.

Introduction:
Although understanding real-world treatment patterns for inflammatory bowel disease (IBD) from initial diagnosis across age groups is essential, most studies focus on adult populations and advanced therapies.

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