Increased prevalence of anti‐TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Abstract

Summary Background Anti‐tumour necrosis factor‐α (anti‐TNF) therapy use has risen in paediatric‐onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti‐TNF‐therapy and surgery. Aim To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti‐TNF‐therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). Results Eight‐hundred‐and‐twenty‐five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD‐unclassified), mean age at diagnosis 13.6 years (1.6‐17.6), 39.6% female. The prevalence of anti‐TNF‐treated patients increased from 5.1% to 27.1% (2007‐2017), P = 0.0001. Surgical resection‐rate fell (7.1%‐1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%‐2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection‐rates were unchanged. Time from diagnosis to resection increased (1.6‐2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007‐2011 = 13.1 years, 2013‐2017 = 11.9 years, P = 0.014). Resection‐rate in anti‐TNF‐therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti‐TNF‐therapy <3 years post‐diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti‐TNF‐therapy prevalence was the only significant predictor of resection‐rate using multivariate regression (P = 0.011). Conclusions The prevalence of anti‐TNF‐therapy increased significantly, alongside a decrease in surgical resection‐rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti‐TNF‐therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.

A Review on the Use of Anti-TNF in Children and Adolescents with Inflammatory Bowel Disease

“…A recent study in the Southampton Children’s Hospital showed a decreased surgical rate between 2007 and 2017 from 7.1% to 5.1%, respectively, which was most pronounced in patients with CD (8.9% vs. 2.3%). Although the resection rate in patients treated with anti-TNF therapy was not significantly different from those who were not, a multivariate regression analysis showed anti-TNF therapy prevalence per year was the only significant predictor associated with reduction in surgical resection rate [13].…”

Biologic therapy is associated with a mild decrease in the rate of hospitalizations in pediatric IBD

“…Moreover, there was no change in the rate of hospitalization before and after treatment among the children receiving biologic therapy, except for patients that were treated during 2016-2019. In concurrence with the reported increase in the incidence of pediatric IBD [30], the rate of biologic therapy and, specifically, anti-TNF-α agents, is increasing worldwide among both adults and children [31][32][33][34] and is now the cornerstone in the treatment of IBD. This trend caused a significant increase in healthcare costs attributable to IBD [35][36][37].…”

Multiomic features associated with mucosal healing and inflammation in paediatric Crohn’s disease

“…Over 25% of all paediatric CD patients are now escalated to anti-TNF and other biological therapies, 10 but approximately one in three patients will not have a sustained response to maximal medical therapy. 11,12 The gastrointestinal microbiome has an important role in mucosal immune homoeostasis and evidence from epidemiological studies and mouse models suggest it is involved in the pathogenesis of CD.…”

“…Inducing and maintaining mucosal healing is a major challenge. Over 25% of all paediatric CD patients are now escalated to anti‐TNF and other biological therapies, 10 but approximately one in three patients will not have a sustained response to maximal medical therapy 11,12 …”