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Early inflammatory bowel disease: different treatment response to specific or all medications?

James Markowitz1

  • 1Division of Pediatric Gastroenterology and Nutrition, Schneider Children's Hospital, North Shore - LIJ Health System, New Hyde Park, NY 11040, USA. jmarkowi2@nshs.edu

Digestive Diseases (Basel, Switzerland)
|September 30, 2009
PubMed

Insights

Pediatric inflammatory bowel disease (IBD) patients show similar acute responses but potentially better prolonged responses to treatments compared to adults. Study design, not age, likely explains these differences, supporting early aggressive therapy.

Area of Science:

  • Gastroenterology
  • Pediatric Gastroenterology
  • Clinical Pharmacology

Background:

  • Literature suggests potential differences in medication efficacy for pediatric versus adult inflammatory bowel disease (IBD).
  • Existing studies present challenges in direct comparison due to variations in disease duration and concurrent treatments.
  • Understanding age-related treatment responses is crucial for optimizing IBD management.

Purpose of the Study:

  • To compare treatment response data between pediatric and adult populations with Crohn's disease (CD).
  • To evaluate the influence of study design factors on observed differences in treatment efficacy.
  • To inform therapeutic strategies for maximizing remission rates in IBD patients.

Main Methods:

  • Systematic review of key clinical trials, meta-analyses, and observational registries.
  • Inclusion of studies with treatment response data from both pediatric and adult CD cohorts.
  • Analysis focused on comparing outcomes for corticosteroids, thiopurines, and infliximab.

Main Results:

  • Acute corticosteroid response is comparable (84-89% pediatric vs. 80-84% adult); prolonged response may favor children (50-61% vs. 32-44%).
  • Pediatric CD remission rates with thiopurines (6 months: 85% vs. 31%; 15-18 months: 81% vs. 42%) and infliximab (1 year: 56% vs. 28%) appear higher, likely influenced by shorter disease duration in pediatric studies.
  • Observed differences in treatment efficacy are largely attributable to variations in disease duration and use of concomitant immunomodulators across studies.

Conclusions:

  • Differences in pediatric versus adult IBD treatment responses are primarily attributed to study design rather than patient age.
  • Pediatric trials, often using potent treatments early in the disease course, show consistently higher response rates.
  • Findings support a 'top-down' therapeutic approach for maximizing remission rates in all IBD patients.
Abstract

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