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Differences in disease characteristics and treatment exposures between paediatric and adult-onset inflammatory bowel
Maya Granot1,2, Uri Kopylov2,3, Nurit Loberman-Nachum1,2
1Division of Pediatric Gastroenterology and Nutrition, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Children with inflammatory bowel disease (IBD) experience more extensive disease and require earlier, more intensive treatments, including biologics, compared to adults. This highlights significant differences in disease progression and management between paediatric-onset and adult-onset IBD.
Area of Science:
- Gastroenterology and Hepatology
- Paediatric Medicine
- Immunology
Background:
- Previous research indicated more severe phenotypes in paediatric-onset inflammatory bowel disease (IBD) compared to adult-onset IBD.
- However, many prior studies lacked long-term data and predated the widespread use of biologic therapies.
Purpose of the Study:
- To conduct a comparative analysis of disease characteristics and treatment exposures in paediatric-onset versus adult-onset IBD.
- To evaluate long-term outcomes and treatment patterns in distinct IBD onset groups.
Main Methods:
- Utilized a registry with uniform data collection on demographics, disease phenotype, and treatments.
- Compared patients diagnosed with IBD between 2000-2022, with at least 12 months of follow-up.
- Stratified analysis between paediatric-onset (diagnosed 6-17 years) and adult-onset IBD.
Main Results:
- Paediatric-onset IBD patients (n=853) presented with more extensive disease and received more intensified therapies than adult-onset IBD patients (n=3316).
- Paediatric-onset ulcerative colitis showed higher rates of extensive colitis and greater need for steroids, immunomodulators, and biologics.
- Paediatric-onset Crohn's disease exhibited more ileocolonic and perianal involvement, with increased use of immunomodulators and biologics.
- Significantly lower 15-year biologic-free survival was observed in paediatric-onset IBD (p < 0.001).
Conclusions:
- Paediatric-onset IBD is characterized by more extensive disease manifestations.
- Patients with paediatric-onset IBD experience higher exposure to immunomodulators and biologic therapies.
- Earlier and more frequent use of advanced therapies is necessary for paediatric-onset IBD compared to adult-onset IBD.
Background:
Previous studies highlighted a more extensive phenotype for paediatric-onset than adult-onset inflammatory bowel disease (IBD). However, most lacked long-term follow-up, and some were conducted before the era of biologics.
Aims:
The aim of this study is to compare disease characteristics and treatment exposures between paediatric-onset and adult-onset IBD.
Methods:
From a registry that periodically and uniformly retrieves demographics, disease characteristics/phenotype, and treatments, we compared the characteristics of paediatric-onset (diagnosed at ≥6 and <18 years) and adult-onset IBD, diagnosed during 2000-2022 and with ≥12 months follow-up.
Results:
Of the 2837 patients with Crohn's disease and 1332 with ulcerative colitis, 3316 had adult-onset and 853 paediatric-onset IBD. The median follow-up was 6 years. Patients with paediatric-onset presented with more extensive disease and received more intensified therapies, including biologics and JAK inhibitors than those with adult-onset IBD. Paediatric-onset ulcerative colitis showed a higher prevalence of E3 extensive colitis including pancolitis and a greater requirement for systemic steroids, immunomodulators, and biologics than adult-onset ulcerative colitis. Paediatric-onset versus adult-onset Crohn's disease exhibited greater L3 ileocolonic involvement and perianal disease phenotype, and higher exposure to immunomodulators and biologics. Kaplan-Meier curve and Cox proportional hazards analyses showed significantly lower 15-year biologic-free survival from diagnosis among those with paediatric-onset IBD than with adult-onset IBD (p = <0.001), indicating greater and earlier use of biologics in the former.
Conclusions:
Paediatric-onset presents with more extensive disease with higher exposures to immunomodulators and biologic therapies than adult-onset IBD.
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