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Prognosis of pediatric ulcerative colitis after infliximab failure: A multicenter registry-based cohort study
Ryusuke Nambu1, Takahiro Kudo2, Nao Tachibana3
1Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan.
Insights
Pediatric ulcerative colitis (UC) patients discontinuing infliximab (IFX) have a high colectomy rate. Prognosis improved after mid-2018 due to new biologic agents and small-molecule drugs becoming available.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Immunomodulatory Therapies
Background:
- Infliximab (IFX) is a key biologic for pediatric ulcerative colitis (UC).
- Limited data exists on outcomes after IFX discontinuation in pediatric UC.
- Understanding IFX failure is crucial for treatment optimization.
Purpose of the Study:
- To investigate the clinical course and prognosis of pediatric UC patients after IFX failure.
- To identify risk factors associated with IFX discontinuation in pediatric UC.
- To evaluate colectomy rates and prognostic changes over time.
Main Methods:
- Prospective cohort study using the Japanese Pediatric Inflammatory Bowel Disease Registry (2012-2020).
- Analysis of 75 pediatric UC patients treated with IFX, focusing on 36 who discontinued therapy.
- Statistical analysis of risk factors and colectomy rates post-IFX failure.
Main Results:
- Severity of UC at onset and lack of immunomodulator therapy were significant risk factors for IFX failure.
- Cumulative colectomy rates reached 41.3% at 1 year and 47.5% at 2 years post-IFX failure.
- Colectomy rates were higher for IFX discontinuation before mid-2018, suggesting improved outcomes with newer therapies.
Conclusions:
- Approximately 50% of pediatric UC patients undergo colectomy within two years of IFX failure.
- The availability of new biologic agents and small-molecule drugs since mid-2018 appears to improve prognosis after IFX failure.
- Early identification of risk factors for IFX failure is essential for managing pediatric UC.
Background And Aim:
Even with increasing numbers of biologic agents available for management of ulcerative colitis (UC), infliximab (IFX) retains an important place in treatment of pediatric patients with this disease. As few reports have addressed outcomes in pediatric UC patients who had to discontinue IFX, we examined clinical course and prognosis after IFX failure in pediatric UC.
Methods:
A prospective cohort study of pertinent cases enrolled in the Japanese Pediatric Inflammatory Bowel Disease Registry between 2012 and 2020 was conducted to determine outcomes for pediatric UC patients who received IFX but required its discontinuation during follow-up (IFX failure).
Results:
Of the 301 pediatric UC patients in the registry, 75 were treated with IFX; in 36 of these, IFX was discontinued during follow-up. Severity of UC at onset and absence of concomitant immunomodulator therapy were significant risk factors for IFX failure (P = 0.005 and P = 0.02, respectively). The cumulative colectomy rate after IFX failure was 41.3% at 1 year and 47.5% at 2 years. Colectomy was significantly more frequent when IFX was discontinued before June 1, 2018, than when IFX was discontinued later (P = 0.013). This difference likely involves availability of additional biologic agents for treatment of UC beginning in mid-2018 (P = 0.005).
Conclusion:
In pediatric UC patients, approximately 50% underwent colectomy during a 2-year interval following IFX failure. Prognosis after IFX failure appeared to improve with availability of new biologic agents and small-molecule drugs in mid-2018.
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