Early Anti-Tumor-Necrosis-Factor Therapy for Crohn's Disease-Related Abdominal Abscesses and Phlegmon in Children
Brad D Constant1,2, Edwin F de Zoeten3, Jason P Weinman3,4
1Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA. constantb1@chop.edu.
Insights
Early initiation of anti-tumor necrosis factor-α (Anti-TNF) therapy in pediatric Crohn's Disease patients with penetrating complications is safe and effective. This approach reduced infectious adverse events without increasing other complications, improving clinical outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Immunomodulatory Therapy
Background:
- Internally penetrating Crohn's Disease (CD) complications, such as abscesses and phlegmon, signify a high-risk CD phenotype.
- Anti-tumor necrosis factor-α (Anti-TNF) therapies are established treatments for penetrating CD, but their timing in relation to complication resolution is debated due to infection concerns.
- Emerging evidence suggests the risk of serious infections with early Anti-TNF initiation may be lower than previously thought.
Purpose of the Study:
- To evaluate the safety and effectiveness of initiating Anti-TNF therapy before the resolution of internally penetrating Crohn's Disease complications in pediatric patients.
- To describe the multidisciplinary management strategies employed for these complex pediatric cases.
- To compare adverse event rates between patients receiving Anti-TNF therapy before and after complication resolution.
Main Methods:
- A single-center retrospective cohort study was conducted involving pediatric patients diagnosed with internally penetrating Crohn's Disease complications between 2007 and 2021.
- Patients were categorized based on whether Anti-TNF therapy was initiated before or after complication resolution.
- Rates of infectious and CD-related adverse events (surgeries, hospitalizations) were compared between the two groups.
Main Results:
- Of 21 identified patients, 7 initiated Anti-TNF therapy prior to complication resolution.
- No infectious adverse events occurred within 90 days in the group receiving early Anti-TNF therapy, compared to 10 out of 14 patients who did not (p=0.004).
- Rates of CD-related surgeries and hospitalizations within one year were similar between groups.
Conclusions:
- Initiating Anti-TNF therapy before the resolution of internally penetrating Crohn's Disease complications appears to be a safe strategy in pediatric patients.
- Early Anti-TNF initiation may improve clinical outcomes by reducing infectious complications.
- This finding supports a potential shift in management guidelines for high-risk Crohn's Disease.
Background:
Internally penetrating Crohn's Disease complications, including abscesses and phlegmon, represent a high-risk Crohn's Disease phenotype. Anti-tumor-necrosis-factor-α (Anti-TNF) therapies are effective in treating penetrating Crohn's Disease and early initiation has shown unique benefits. However, timing of anti-TNF initiation in the setting of internally penetrating Crohn's Disease complications is typically heterogenous due to concern over precipitating serious infections. Recent studies demonstrate such an association may not exist.
Aims:
We aimed to describe the multidisciplinary management of pediatric patients with internally penetrating Crohn's Disease complications, focusing on the utilization and timing of anti-TNF therapy relative to complication resolution and adverse events.
Methods:
We performed a single-center retrospective cohort study of pediatric patients with internally penetrating Crohn's Disease complications from 2007 to 2021. The safety and effectiveness of anti-TNF therapy initiation prior to complication resolution was assessed by comparing rates of infectious and Crohn's Disease-related adverse events between those who received anti-TNF therapy prior to complication resolution, versus those who did not.
Results:
Twenty-one patients with internally penetrating Crohn's Disease complications were identified. 7/21 received anti-TNF therapy prior to complication resolution. Infectious adverse events within 90 days of complication occurred in 0/7 patients initiating anti-TNF therapy prior to complication resolution and 10/14 patients who did not (p = 0.004). Crohn's Disease-related surgeries and hospitalizations within 1 year of complication occurred in 12/20 patients, with similar frequency between groups.
Conclusions:
Initiating anti-TNF therapy prior to internally penetrating Crohn's Disease complication resolution may be a safe and effective strategy to improve clinical outcomes.
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