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Advanced therapy is delayed in pediatric South Asian inflammatory bowel disease patients in the United States
Megha Tandon1, Jennifer Bachand2, Nurgul Yegembayeva3
1Tufts University School of Medicine, Boston, Massachusetts, USA.
Insights
South Asian pediatric inflammatory bowel disease (SA pIBD) patients present with unique characteristics and are less likely to initiate biologic therapies. This highlights differences in treatment approaches for this demographic.
Area of Science:
- Gastroenterology
- Pediatrics
- Immunology
Background:
- South Asian pediatric inflammatory bowel disease (SA pIBD) is an emerging demographic with poorly understood disease characteristics and treatment patterns in the U.S.
- Understanding these differences is crucial for optimizing care for SA pIBD patients.
Purpose of the Study:
- To characterize the disease presentation and treatment strategies for SA pIBD in the United States.
- To compare SA pIBD patients with their non-South Asian (NSA) counterparts.
Main Methods:
- A retrospective cohort study involving 147 pediatric inflammatory bowel disease (pIBD) patients.
- Matched 55 SA pIBD patients with 92 NSA pIBD patients based on age, sex, and disease subtype.
- Analyzed demographics, disease extent/severity, treatment utilization, and patient perspectives.
Main Results:
- SA pIBD patients presented at a mean age of 12, with male predominance and a majority diagnosed with Crohn's disease.
- SA pIBD patients more frequently exhibited weight loss, left-sided disease, upper GI involvement, and elevated ESR.
- SA pIBD patients were significantly less likely to initiate biologic therapies (9.1% vs. 30.4%) and had lower cumulative biologic use.
Conclusions:
- SA pIBD exhibits distinct phenotypic features compared to NSA pIBD.
- SA pIBD patients are less likely to initiate biologic therapies and experience a longer time to biologic initiation.
Objectives:
South Asian pediatric inflammatory bowel disease (SA pIBD) is a novel at-risk demographic group for pediatric IBD. However, the disease characteristics and treatment strategies for SA pIBD in the United States remain poorly described.
Methods:
In this retrospective cohort study of 147 patients, SA patients with pIBD (n = 55) were matched (~1:2) to non-South Asian (NSA, n = 92) patients with pIBD by age, sex, and disease subtype. Study outcomes included demographics, disease extent and severity, treatments utilized, and patient perspectives on pIBD and its treatment.
Results:
Among 55 SA and matched 92 NSA pIBD patients, mean age of presentation was 12 years old, with male predominance (65%), and majority with a Crohn's diagnosis (65%). Very early-onset IBD (VEOIBD) was reported in 5.5% of SA pIBD. SA pIBD patients more frequently presented with weight loss, left-sided disease, upper gastrointestinal manifestations, and elevated erythrocyte sedimentation rate. SA pIBD patients were less likely to use biologic therapies as their initial treatment (9.1% vs. 30.4%, p < 0.005), with a lower cumulative rate of biologic use. Instead, SA pIBD were more likely to use mesalamine or other treatments as their initial therapy.
Conclusions:
SA pIBD had unique phenotypic characteristics compared to NSA pIBD. SA pIBD patients were less likely to initiate biologic therapies as their initial treatment and had a longer time-to-initiation of biologic therapies.
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