How has the disease course of pediatric ulcerative colitis changed throughout the biologics era? A comparison with
Yiyoung Kwon1, Eun Sil Kim2, Yon Ho Choe1
1Department of Pediatrics, Samsung Medical Center, Seoul 06351, South Korea.
Insights
The introduction of biological agents significantly improved outcomes for pediatric ulcerative colitis patients in Korea, leading to increased remission rates and longer steroid-free periods. This suggests biologicals may alter the long-term disease course for children with moderate to severe UC.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Clinical Therapeutics
Background:
- Infliximab, a biological agent, was approved for pediatric ulcerative colitis (UC) in Korea in October 2012.
- This study examines the impact of biological agents on the clinical course of pediatric UC.
Purpose of the Study:
- To compare the clinical course of pediatric ulcerative colitis (UC) before and after the introduction of biological agents.
- To compare outcomes with the IBSEN study cohort.
Main Methods:
- Retrospective analysis of pediatric UC patients (under 18) from January 2003 to October 2020.
- Group A (pre-biologicals, n=48) and Group B (post-biologicals, n=62) were followed for at least 2 years.
- Comparison of endoscopic remission, drug use, relapse rates, steroid-free periods, and quality of life.
Main Results:
- Group B showed significantly higher remission rates (50.0%) compared to Group A (29.2%) after 2 years (P < 0.012).
- The median steroid-free period was longer in Group B (4.4 years) than Group A (3.0 years) (P < 0.001).
- Relapse rates decreased, and the clinical course in Group B differed from the IBSEN study, with 76% achieving remission or mild severity.
Conclusions:
- Introduction of biological agents in pediatric UC correlates with decreased relapse incidence and extended steroid-free periods.
- The clinical course of pediatric UC appears to be altered by the active use of biological agents.
- Biological therapies may positively influence the long-term disease trajectory in moderate to severe pediatric UC.
Background:
In Korea, infliximab was approved for use in children with ulcerative colitis (UC) in October 2012.
Aim:
To compare the clinical course of UC before and after the introduction of biological agents, and to compare with the IBSEN study.
Methods:
Patients under 18 years of age, who were diagnosed with UC and followed from January 2003 to October 2020, were included in the study. Group A (n = 48) was followed for at least 2 years between January 2003 and October 2012, and Group B (n = 62) was followed for at least 2 years between November 2012 and October 2020. We compared endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of each group. We plotted the clinical course of the included patients using the pediatric UC activity index score, and compared our patients with those in the IBSEN study.
Results:
After 2 years of treatment, colonoscopy evaluation revealed different outcomes in the two treatment groups. Remission was confirmed in 14 patients (29.2%) of Group A, and in 31 patients (50.0%) of Group B (P < 0.012). The median cumulative corticosteroid-free period was 3.0 years in Group A and 4.4 years in Group B. Steroid-free period of Group B was significantly longer than that of Group A (P < 0.001). There was a statistically significant difference between the two groups in evaluation of the relapse rate during the observation period (P < 0.001). The plotted clinical course graphs of Group A showed similar proportions to the graphs in the IBSEN study. However, in Group B, the proportion of patients corresponding to curve 1 (remission or mild severity after initial high activity) was high at 76% (47/62).
Conclusion:
The incidence of relapse has decreased and the steroid-free period has increased after the introduction of the biological agent. The clinical course also showed a different pattern from that of IBSEN study. The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC.
Related Concept Videos
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Drugs for Treatment of Ulcerative Colitis in IBD
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF