Treatment and biologic maintenance-dosing patterns among pediatric patients with ulcerative colitis or Crohn's
Theresa Hunter1, Wendy J Komocsar1, Richard B Colletti2
1Eli Lilly and Company, Indianapolis, IN, USA.
Insights
Treatment patterns for pediatric ulcerative colitis (UC) and Crohn
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Biologics and Immunotherapy
Background:
- Pediatric ulcerative colitis (UC) and Crohn's disease (CD) management involves complex treatment strategies.
- Understanding biologic dosing and treatment shifts is crucial for optimizing long-term outcomes in pediatric IBD.
- The ImproveCareNow registry provides valuable real-world data on pediatric IBD care.
Purpose of the Study:
- To analyze 3-year treatment patterns for biologics in pediatric patients with UC and CD.
- To evaluate initial and maintenance dosing of biologics in this population.
- To identify trends in medication use over time.
Main Methods:
- Retrospective analysis of pediatric patients (2-17 years) with UC or CD from the ImproveCareNow registry.
- Cohort 1: Assessed medication use at baseline, 1-year, and 3-year time points.
- Cohort 2: Calculated biologic maintenance dosages based on available dose and weight data.
Main Results:
- In UC, 5-ASA and corticosteroid use decreased, while 6-MP/AZA and anti-TNF use increased over 3 years.
- In CD, corticosteroid use decreased, with increased use of methotrexate and anti-TNFs.
- Observed maintenance doses for infliximab, adalimumab, and vedolizumab in both UC and CD patients.
Conclusions:
- Corticosteroid use was frequent initially, but decreased over time.
- Anti-TNF agents remain the most utilized biologics in pediatric IBD.
- Reported biologic doses were often higher than standard guidelines.
Objectives:
To assess treatment patterns and initial and maintenance dosing of biologics over 3 years in pediatric patients with ulcerative colitis (UC) or Crohn's disease (CD), utilizing data from the ImproveCareNow registry.
Methods:
Pediatric patients diagnosed with UC or CD and aged 2-17 years were included in the study. Descriptive statistics were employed to summarize baseline demographics. The proportion of patients on medication for UC or CD were analyzed at the baseline visit, 1-year, and 3-year time points (Cohort 1). Biologic maintenance dosage was calculated only for patients who had data for dose and weight at all-time points (Cohort 2).
Results:
In Cohort 1 (UC = 1784; CD = 4720), baseline treatment in UC included corticosteroid, 5-ASA, and 6-MP/AZA; at 1-year and 3-year time points, treatment with 5-ASA and corticosteroid decreased, whereas 6-MP/AZA and anti-TNFs increased. In CD, baseline treatment included corticosteroid, anti-TNF, 6-MP/AZA, and methotrexate; use of corticosteroids decreased, whereas the use of methotrexate and anti-TNFs increased over 3 years. In Cohort 2 (UC = 350; CD = 1537), at first maintenance dose, UC patients on infliximab received a mean dose of 10.5 mg/kg/8 wk, adalimumab (weight < 40 kg and ≥40 kg) 1.3 mg/kg/2 wk and 0.8 mg/kg/2 wk, and vedolizumab 6.9 mg/kg/8 wks. At the first maintenance dose, CD patients on infliximab received a mean dose of 8.1 mg/kg/8 wk, adalimumab (weight < 40 kg) 1.1 mg/kg/2 wk, adalimumab (weight ≥ 40 kg) 0.8 mg/kg/2 wk, and vedolizumab 10.5 mg/kg/8 wks.
Conclusion:
The use of corticosteroids was common at the initial visit in patients. Anti-TNFs remain the most used class of biologics, however, reported doses in our study were substantially higher than the standard dosing guidelines.
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