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New Therapeutic Strategies Are Associated With a Significant Decrease in Colectomy Rate in Pediatric Ulcerative
Delphine Ley1,2, Ariane Leroyer2,3, Claire Dupont4
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, CHU Lille, Lille, France.
Insights
The introduction of immunosuppressants (IS) and antitumor necrosis factor (TNF) therapies significantly reduced colectomy risk in pediatric ulcerative colitis (UC) patients. However, flare-related hospitalizations increased with these advanced treatments.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes Analysis
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting children.
- Long-term outcomes in pediatric UC have been influenced by evolving treatment paradigms.
- Understanding the impact of immunosuppressants (IS) and antitumor necrosis factor (TNF) therapies is crucial.
Purpose of the Study:
- To evaluate the long-term effects of IS and anti-TNF introduction on pediatric-onset UC outcomes.
- To compare disease progression and treatment outcomes across different eras of therapy.
- To analyze population-level trends in colectomy, disease extension, and hospitalization.
Main Methods:
- Retrospective analysis of a large, population-based pediatric UC cohort (EPIMAD registry).
- Patients diagnosed before age 17 between 1988 and 2011 were followed until 2013.
- Comparison of outcomes across three diagnostic periods: pre-IS, pre-anti-TNF, and anti-TNF eras.
Main Results:
- IS and anti-TNF use increased significantly over time, reaching 63.8% and 37.2% by 5 years in the latest era.
- The 5-year risk of colectomy decreased significantly from 17% in the pre-IS era to 9% in the anti-TNF era (P=0.013).
- Flare-related hospitalizations at 5 years significantly increased from 16% to 42% (P=0.0004) with newer therapies.
Conclusions:
- Increased use of IS and anti-TNF therapies is associated with a substantial reduction in colectomy rates for pediatric UC.
- While colectomy risk decreased, the risk of flare-related hospitalizations rose, indicating a complex treatment benefit-risk profile.
- These findings highlight the evolving landscape of pediatric UC management and its population-level impact.
Introduction:
We evaluated the impact of immunosuppressants (IS) and antitumor necrosis factor (TNF) introduction on long-term outcomes of ulcerative colitis (UC) in a large population-based pediatric-onset cohort.
Methods:
All patients included in the EPIMAD registry with a diagnosis of UC made before the age of 17 years between 1988 and 2011 were followed up retrospectively until 2013. Medication exposure and disease outcomes were compared between 3 diagnostic periods: 1988 to 1993 (period [P] 1; pre-IS era), 1994 to 2000 (P2; pre-anti-TNF era), and 2001 to 2011 (P3; anti-TNF era).
Results:
A total of 337 patients (female, 57%) diagnosed with UC were followed up during a median duration of 7.2 years (interquartile range 3.8-13.0). The IS and anti-TNF exposure rates at 5 years increased over time from 7.8% (P1) to 63.8% (P3) and from 0% (P1) to 37.2% (P3), respectively. In parallel, the risk of colectomy at 5 years decreased significantly over time (P1, 17%; P2, 19%; and P3, 9%; P = 0.045, P -trend = 0.027) and between the pre-anti-TNF era (P1 + P2, 18%) and the anti-TNF era (P3, 9%) ( P = 0.013). The risk of disease extension at 5 years remained stable over time (P1, 36%, P2, 32%, and P3, 34%; P = 0.31, P -trend = 0.52) and between the pre-anti-TNF era (P1 + P2, 34%) and the anti-TNF era (P3, 34%) ( P = 0.92). The risk of flare-related hospitalization at 5 years significantly increased over time (P1, 16%; P2, 27%; P3, 42%; P = 0.0012, P -trend = 0.0006) and between the pre-anti-TNF era (P1 + P2, 23%) and the anti-TNF era (P3, 42%) ( P = 0.0004).
Discussion:
In parallel with the increased use of IS and anti-TNF, an important decline in the risk of colectomy in pediatric-onset UC was observed at the population level.
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