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Trends of Utilization of Tumor Necrosis Factor Antagonists in Children With Inflammatory Bowel Disease: A Canadian
Wael El-Matary1,2, Stella Leung3, Aruni Tennakoon3
1Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Anti-tumor necrosis factor (anti-TNF) therapies are increasingly used earlier in pediatric inflammatory bowel disease (IBD) management. This trend is associated with a significant decrease in corticosteroid use over 11 years.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Pharmacology
Background:
- Limited population-based data exist on anti-tumor necrosis factor (anti-TNF) antagonist use in pediatric inflammatory bowel disease (IBD).
- Understanding trends in anti-TNF utilization is crucial for optimizing treatment strategies in young IBD patients.
Purpose of the Study:
- To analyze the temporal trends of anti-TNF antagonist utilization in children and young adults diagnosed with IBD.
- To assess changes in the timing of anti-TNF initiation and its association with corticosteroid use.
Main Methods:
- Population-based survival analysis of pediatric IBD patients (diagnosed before age 18) in Manitoba.
- Comparison of anti-TNF initiation rates across different time eras (2005-2008, 2008-2012, 2012-2016).
- Evaluation of corticosteroid cumulative doses prior to anti-TNF initiation.
Main Results:
- The proportion of pediatric IBD patients receiving anti-TNFs increased significantly over time, with earlier initiation post-diagnosis observed.
- By 2016, 60.0% of pediatric Crohn's disease and 25.5% of pediatric ulcerative colitis patients were on anti-TNFs.
- Initiation of anti-TNFs without prior immunosuppressive therapy increased, and median cumulative corticosteroid doses decreased substantially over the study period.
Conclusions:
- Anti-TNF therapy is being initiated earlier in the course of pediatric IBD.
- This shift towards earlier anti-TNF use correlates with a reduction in cumulative corticosteroid exposure.
Background:
Population-based studies examining the prevalence of anti-tumor necrosis factor (anti-TNF) antagonist utilization in children and young adults with inflammatory bowel disease (IBD) are lacking. We aimed to describe the trend of anti-TNF utilization in pediatric IBD over time.
Methods:
Survival analyses were performed for all patients diagnosed with IBD before age 18 years in the province of Manitoba to determine the time from diagnosis to first anti-TNF prescription in different time eras (2005-2008, 2008-2012, 2012-2016).
Results:
There were 291 persons diagnosed with IBD (157 with Crohn's disease [CD] and 134 with ulcerative colitis [UC]) over the study period. The likelihood of being initiated on an anti-TNF by 1, 2, and 5 years postdiagnosis was 18.4%, 30.5%, and 42.6%, respectively. The proportion of persons aged <18 years utilizing anti-TNFs rose over time; in 2010, 13.0% of CD and 4.9% of UC; by 2016, 60.0% of CD and 25.5% of UC. For those diagnosed after 2012, 42.5% of CD and 28.4% of UC patients had been prescribed an anti-TNF antagonist within 12 months of IBD diagnosis. Initiating an anti-TNF without prior exposure to an immunosuppressive agent increased over time (before 2008: 0%; 2008-2012: 18.2%; 2012-2016: 42.8%; P < 0.001). There was a significant reduction in median cumulative dose of corticosteroids (CS) in the year before anti-TNF initiation (2005-2008: 4360 mg; 2008-2012: 2010 mg; 2012-2016: 1395 mg prednisone equivalents; P < 0.001).
Conclusions:
Over a period of 11 years, anti-TNFs are being used earlier in the course of pediatric IBD, with a parallel reduction in the cumulative CS dose.
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