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Clinical outcomes in pediatric inflammatory bowel disease patients: a systematic review of prospective studies
Jonathan Van Hecke1, Lucas Wauters2, Gigi Veereman1,3
1Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Insights
Prospective studies show reduced disease activity in pediatric inflammatory bowel disease (IBD) after one year, with stable outcomes observed long-term. Real-world data indicate improvements in inactive disease and reduced moderate-to-severe cases.
Area of Science:
- Pediatric gastroenterology
- Inflammatory bowel disease (IBD) research
- Real-world evidence in chronic disease management
Background:
- Investigating treatment response and remission rates in pediatric inflammatory bowel disease (IBD) using prospectively collected real-world data.
- Assessing disease activity and phenotype changes over time in children and adolescents diagnosed with IBD.
Approach:
- Systematic literature search of MEDLINE, Embase, and Improve Care Now registry up to March 2022.
- Inclusion of prospective studies with patients under 18 at diagnosis and at least one-year follow-up.
- Exclusion of retrospective studies and those solely reporting disease activity at diagnosis or steroid-free remission.
Key Points:
- Analysis of 7 studies with 888 pediatric IBD patients (median follow-up 1-5 years) revealed significant decreases in disease activity by year one.
- A notable reduction in moderate-to-severe disease activity and an increase in inactive disease were observed at one year.
- Global disease activity did not significantly differ after one year, and Belgian Crohn's disease cohort showed stable activity between 1- and 5-year follow-ups.
Conclusions:
- Prospective pediatric IBD cohorts demonstrate a significant initial improvement in disease activity within the first year.
- Long-term follow-up suggests that disease activity remains stable after the initial one-year period.
- Real-world data indicate sustained therapeutic benefits and stable disease control in pediatric IBD patients over time.
Background And Aim:
We studied response and remission rates in children and adolescents with inflammatory bowel disease whose real-world data were collected prospectively.
Methods:
A systematic literature search was performed in MEDLINE, Embase, and the Improve Care Now registry from inception until March 17, 2022. Inclusion criteria were prospective studies with patients < 18 years at diagnosis (M0) and minimum follow-up of 1 year (M12) mentioning disease phenotype and disease activity. Exclusion criteria were (i) reporting disease activity only at diagnosis, (ii) retrospective studies, and (iii) outcome limited to steroid-free remission. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines and the Newcastle-Ottawa scale were applied. Proportions between groups were compared using a chi-square test (α = 0.05).
Results:
The search yielded 394 records and 7 inclusions with a sample size ranging from 33 to 390 patients (total population: 888) and a median follow-up of 1-5 years. Proportions of disease activity differed between M0 and M12 (P < 0.0001) with more inactive (χ2 = 5.5) and less moderate-to-severe disease (χ2 = 23) at M12. Interestingly, disease activity after 1 year did not differ globally (P = 0.53). Proportions of disease activity in Crohn's disease only and limited to Belgium significantly differed from baseline after 5 years (P < 0.0001 for evolution) but not between 1- and 5-year follow-up (P = 0.94).
Conclusions:
The few available prospective cohorts reported a significant decrease in disease activity after 1 year, with no global differences. Proportions of disease activity did not differ between 1- and 5-year follow-up in the Belgian Crohn's disease cohort, suggesting stable disease activity.
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