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The inexorable increase of biologic exposure in paediatric inflammatory bowel disease: a Scottish, population-based,
Christopher J Burgess1,2, Rebecca Jackson3, Iain Chalmers4
1Child Life and Health, University of Edinburgh, Edinburgh, UK.
Insights
Biologic use in paediatric inflammatory bowel disease (PIBD) is increasing, with shifts in drug choices and rising prevalence. Adalimumab, vedolizumab, and ustekinumab use is growing, while infliximab use declines.
Area of Science:
- Gastroenterology
- Paediatric Medicine
- Immunology
Background:
- Biologic therapies are transforming the treatment landscape for paediatric-onset inflammatory bowel disease (PIBD).
- Understanding trends in biologic utilization is crucial for optimizing patient care.
Purpose of the Study:
- To determine the incidence and prevalence of biologic use in Scottish PIBD services.
- To describe patient demographics and outcomes for those requiring therapy escalation beyond anti-tumour necrosis factor alpha (anti-TNFα) agents.
Main Methods:
- A nationwide cohort of PIBD patients (<18 years) was prospectively identified over 4.5 years (2015-2019).
- Retrospective audit of patients receiving infliximab, adalimumab, vedolizumab, or ustekinumab, including first-time biologic users.
Main Results:
- Scotland-wide PIBD prevalence increased from 554 to 644 cases.
- New biologic starts (n=495) showed a shift from infliximab (87% to 54%) to adalimumab (13% to 31%), vedolizumab (0% to 9%), and ustekinumab (0% to 6%).
- Point prevalence of biologic use rose from 20.2% to 43.5% (20% annual increase); biosimilar anti-TNFα agent penetration reached 91%.
Conclusions:
- Scottish PIBD biologic usage is rapidly evolving and increasing.
- The landscape of biologic therapies for PIBD is dynamic, necessitating ongoing monitoring and adaptation of treatment strategies.
Background:
The use of biologics in paediatric-onset inflammatory bowel disease (PIBD) is rapidly changing.
Aims:
To identify the incidence and prevalence of biologic use within Scottish PIBD services, and to describe patient demographics and outcomes for those patients who required escalation of therapy beyond anti-tumour necrosis factor alpha (anti-TNFα) agents METHODS: We captured a nationwide cohort of prospectively identified patients less than 18 years of age with PIBD (A1 phenotype; diagnosed <17 years of age) within paediatric services over a 4.5-year period (1 January 2015-30 June 2019). All patients who received infliximab, adalimumab, vedolizumab or ustekinumab during the study period and/or received their first dose of these biologics were audited retrospectively.
Results:
Scotland-wide PIBD-prevalence cases increased from 554 to 644 over the study period. A total of 495 incident new-start biological therapies were commenced on 403 PIBD patients: 295 infliximab (60%), 161 adalimumab (32%), 24 vedolizumab (5%) and 15 ustekunumab (3%). The proportion of new-start biologics changed with infliximab initiation rates decreasing (87%-54%) while adalimumab (13%-31%), vedolizumab (0%-9%) and ustekinumab (0%-6%) all increased. The incidence rate (first dose of new biologic not including biosimilar switch) increased from 6.9% to 8.1% over the study period and point prevalence rates (any biologic use) increased from 20.2% to 43.5% - an average annual percentage increase of 20%. Biosimilar penetration of new-start anti-TNFα agents increased from 3% to 91%. Demographics and outcomes of those patients receiving vedolizumab and ustekinumab were similar.
Conclusions:
Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing, inexorably increasing PIBD biologics landscape.
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