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Long-term outcomes of children with ulcerative colitis after acute severe colitis: A GETAID pédiatrique multicenter
Manon Cochet1, Agathe Beauvais2, Frank Ruemmele1,3
1Service de Gastro-entérologie et Nutrition pédiatrique, Centre de Référence des Maladies rares digestives (MARDI), Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants malades, Université Paris Cité, Paris, France.
Insights
Colectomy rates decrease but remain high after acute severe colitis in pediatric ulcerative colitis patients, even with early biotherapy. Long-term outcomes appear favorable with sustained remission.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes Analysis
Background:
- Acute severe colitis (ASC) is a serious complication of ulcerative colitis (UC) with significant colectomy risk.
- The impact of immunosuppressants and anti-tumor necrosis factor (anti-TNF) agents on colectomy risk in ASC is debated.
- Understanding the long-term outcomes of pediatric-onset UC following ASC is crucial for treatment strategies.
Purpose of the Study:
- To investigate the clinical course and colectomy rates in pediatric-onset UC patients after an ASC episode.
- To identify prognostic factors associated with colectomy risk in this patient population.
- To evaluate the long-term outcomes, including remission rates, in pediatric UC patients post-ASC.
Main Methods:
- Retrospective study across 12 French centers involving pediatric UC patients (<18 years) admitted with ASC (PUCAI score ≥65).
- Data collected at discharge and 1, 3, and 5 years post-admission.
- Colectomy-free survival rates analyzed using uni- and multivariate models to identify prognostic factors.
Main Results:
- Out of 102 patients, 93% received corticosteroids, and 50% escalated to second-line therapy (mainly infliximab).
- Colectomy-free survival rates were 82% at 1 year, 76% at 3 years, and 74% at 5 years.
- New onset UC and treatment with azathioprine or anti-TNF agents were associated with a lower colectomy risk.
Conclusions:
- Despite early biotherapy use, colectomy rates after ASC in pediatric UC remain substantial.
- Long-term outcomes for pediatric-onset UC patients after ASC are generally positive, with sustained clinical and biological remission observed.
- Further research into optimizing ASC management in pediatric UC is warranted.
Objectives:
Acute severe colitis (ASC) is a frequent and severe complication of ulcerative colitis (UC) with a high risk of colectomy. Effects of immunosuppressants and anti-tumor necrosis factor (anti-TNF) agents on the risk of colectomy remain debated. We wished to study the evolution of French pediatric-onset UC patients after ASC.
Methods:
This retrospective study was conducted in 12 French centers of the GETAID pédiatrique group. Data on patients with UC aged <18 years admitted with ASC (defined as Pediatric Ulcerative Colitis Activity Index [PUCAI] score ≥ 65) between January 2010 and December 2020 were collected at discharge and at 1, 3, and 5 years after admission. The primary outcome was colectomy-free rates at 1 year. Uni- and multivariate analyses were performed to identify prognostic factors associated with the risk of surgery.
Results:
Of the 102 patients admitted with ASC, 95 (93%) were treated with corticosteroids. Forty-eight (50%) patients were escalated to second-line therapy, mainly to infliximab. Nine patients (8.8%) underwent colectomy before discharge. Colectomy-free survival rates were 82% at 1 year, 76% at 3 years, and 74% at 5 years. Patients without colectomy were in clinical and biological remission for a long time. In multivariate analysis, new onset UC, treatment with azathioprine or anti-TNF agent, were significantly associated with a lower risk of colectomy.
Conclusions:
The rate of colectomy decreases but remains high after an episode of acute colitis despite early use of biotherapies. But long-term outcome of pediatric-onset UC patients seems good with sustained clinical and biological remission.
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