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Utilization of Antitumor Necrosis Factor Biologics in Very Early Onset Inflammatory Bowel Disease: A Multicenter
Basavaraj Kerur1, Karoline Fiedler2, Marisa Stahl3
1From the University of Massachusetts Medical School (UMMS), Worcester, MA.
Insights
Research shows antitumor necrosis factor (TNF) biologics are utilized and durable in very early onset inflammatory bowel disease (VEOIBD), comparable to older children. Crohn disease patients experienced greater anti-TNF durability than those with ulcerative colitis or IBD unclassified.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Pharmacology
Background:
- Very early onset inflammatory bowel disease (VEOIBD) requires research into antitumor necrosis factor (TNF) biologic utilization and effectiveness.
- Limited data exists on anti-TNF therapy outcomes in this pediatric population.
Purpose of the Study:
- To evaluate the initiation, utilization, and durability of anti-TNF biologics in children diagnosed with VEOIBD.
- To identify factors associated with anti-TNF treatment durability in VEOIBD.
Main Methods:
- Retrospective cohort study of VEOIBD patients (<6 years) diagnosed between 2008-2013 across 25 North American centers.
- Chart abstraction at diagnosis and 1, 3, and 5 years post-diagnosis.
- Multivariate Cox proportional hazard regression analyzed treatment durability against covariates like age, sex, disease classification, and combination therapy.
Main Results:
- 120 of 294 VEOIBD patients initiated anti-TNF therapy; 101 had recorded follow-up.
- Cumulative anti-TNF probability reached 45% at 5 years; durability was 55% at 5 years, with loss of response being the primary discontinuation reason.
- Patients with Crohn disease demonstrated significantly higher anti-TNF durability compared to those with ulcerative colitis or IBD unclassified (HR 0.17; P=0.001).
Conclusions:
- Anti-TNF biologic utilization and durability in VEOIBD are substantial and comparable to older pediatric populations.
- Crohn disease is associated with superior anti-TNF durability in VEOIBD compared to ulcerative colitis or IBD unclassified.
Background:
Research on the utilization and effectiveness of antitumor necrosis factor (TNF) biologics in children with very early onset inflammatory bowel disease (VEOIBD) is urgently needed. Here we describe anti-TNF use and durability in a multicenter cohort.
Methods:
We performed a retrospective cohort study of patients diagnosed with VEOIBD (<6 years) between 2008 and 2013 at 25 North American centers. We performed chart abstraction at diagnosis and 1, 3, and 5 years after diagnosis. We examined the rate of initiation and durability of infliximab and adalimumab and evaluated associations between treatment durability and the following covariates with multivariate Cox proportional hazard regression: age at diagnosis, sex, disease duration, disease classification, and presence of combined immunomodulatory treatment versus monotherapy.
Results:
Of 294 children with VEOIBD, 120 initiated treatment with anti-TNF therapy and 101 had follow-up data recorded [50% Crohn disease (CD), 31% ulcerative colitis (UC), and 19% IBD unclassified (IBD-U)]. The cumulative probability of anti-TNF treatment was 15% at 1 year, 30% at 3 years, and 45% at 5 years from diagnosis; 56 (55%) were treated between 0 and 6 years old. Anti-TNF durability was 90% at 1 year, 75% at 3 years, and 55% at 5 years. The most common reason for discontinuation of anti-TNF were loss of response in 24 (57%) children. Children with UC/IBD-U had lower durability than those with CD (hazard ratio [HR] 0.17; 95% confidence interval [CI], 0.06-0.51; P = 0.001).
Conclusions:
Utilization and durability of anti-TNF in VEOIBD is relatively high and comparable with older children. Having Crohn disease (compared with UC/IBD-U) is associated with greater durability.