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Prognostic Factors of Biologic Therapy in Pediatric IBD
Anna Buczyńska1, Urszula Grzybowska-Chlebowczyk1
1Department of Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland.
Insights
Predicting biologic therapy needs in pediatric inflammatory bowel disease (IBD) is crucial. Factors like perianal disease, fatigue, and hypoalbuminemia at diagnosis can indicate a more severe disease course requiring early intervention.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease (IBD) Research
- Clinical Predictors
Background:
- Pediatric inflammatory bowel disease (pIBD) management requires identifying children likely to experience unfavorable clinical courses.
- Current European Crohn's and Colitis Organisation (ECCO) guidelines emphasize the need for predictors of poor outcomes in pIBD.
- Biologic therapies represent a significant treatment escalation, making prediction of their need essential for timely intervention.
Purpose of the Study:
- To identify clinical and laboratory parameters at diagnosis that predict the subsequent need for biologic therapy in pediatric IBD patients.
- To evaluate these predictors as indicators of an unfavorable clinical course in children with Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Retrospective cohort study of 231 children (119 CD, 112 UC) diagnosed and monitored for at least 1 year between 2009-2019.
- Patients were categorized based on receiving biologic therapy before age 18.
- Logistic regression, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were employed for analysis.
Main Results:
- Significant predictors for biologic therapy included perianal disease, complicated disease behavior, high Pediatric Crohn's Disease Activity Index (PCDAI) in CD, fatigue, hypoalbuminemia, high Pediatric Ulcerative Colitis Activity Index (PUCAI) in UC, fever, hypoproteinemia, and elevated C-reactive protein (CRP) in IBD.
- Marginally significant factors included ileocecal disease, elevated serum IgA, anemia, and L4a-L4b coexistence in CD.
- Hypoalbuminemia in UC and IgA/L4a-L4b coexistence in CD were notable findings beyond established predictors.
Conclusions:
- Clinical and laboratory markers at diagnosis, including fatigue, hypoalbuminemia, and disease behavior, can predict the need for biologic therapy in pediatric IBD.
- These findings aid in identifying children with pIBD at risk for a more severe disease course, guiding early treatment strategies.
- The study highlights the importance of comprehensive assessment at diagnosis to anticipate treatment escalation with biologics.
Abstract:
This was a retrospective cohort study aimed at identifying parameters measured at diagnosis of pediatric IBD to predict subsequent biologic therapy, as an equivalent to an unfavorable clinical course. Identification of predictors of poor outcomes is an important issue in current ECCO guidelines on pIBD. The study population consisted of 119 children with Crohn's disease and 112 with ulcerative colitis, diagnosed and monitored for at least 1 year from 2009-2019. The population was divided into the study groups separately: 39 children with CD and 14 with UC who received biologics before the age of 18 y compared to 80 with CD and 98 with UC who did not. The combined analysis of 53 biologic therapy recipients vs. 178 non-recipients with IBD was also conducted. Logistic regression tests (OR, RR) and sensitivity, specificity, PPV, and NPV were used. Factors significantly correlated with subsequent biologic therapy were perianal disease, complicated disease behavior, high PCDAI (CD), fatigue, hypoalbuminemia, high PUCAI (UC) and fever, fatigue, hypoalbuminemia, hypoproteinemia, and elevated CRP (IBD). Marginally significant factors were ileocecal disease, elevated serum IgA, anemia, and L4a-L4b coexistence. Apart from parameters already accepted as POPO (B2/3, perianal disease), interesting observations are the significance of IgA, L4a-L4b in CD, and hypoalbuminemia in UC.
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