Progression to Anti-TNF Treatment in Very Early Onset Inflammatory Bowel Disease Patients

Abstract

Objectives: Limited data are currently available regarding anti-tumor necrosis factor (TNF) use and outcomes in very early onset inflammatory bowel disease (VEOIBD) patients. We aimed to assess the long-term outcomes and time to progression to anti-TNF treatment in VEOIBD patients. Methods: We retrospectively reviewed IBD patients diagnosed under 6 years of age, between January 2005 and December 2019, from the British-Columbia (BC) Pediatric IBD database. Demographic data, disease characteristics, disease location and severity were documented. Data on anti-TNF treatment at initiation and during follow up including type of biologic, dosing, and response were collected. Kaplan-Meier curves were used to assess the number of years to progression to anti-TNF treatment and the parameters influencing commencement. Results: Eighty-nine patients with VEOIBD were diagnosed during the study period. Median age at diagnosis was 3.8 years [interquartile range (IQR) 2.6-5.1], 45.3% had Crohn disease (CD) and 62.8% were males. Median duration of follow up was 6.39 years ). Anti-TNF treatment was started on 39.5% of patients and 7.0% underwent surgery. Rapid progression to biologic treatment was associated with Perianal fistulizing disease or stricturing disease in CD patients (P = 0.026, P = 0.033, respectively), and disease severity (P = 0.017) in ulcerative colitis (UC) patients. The median dose of infliximab at 1 year was 10 mg/kg (IQR 7.5-11) and a median dose interval of 4.5 weeks (IQR 4-6). Clinical remission was reported in 61.8% of patients on their first biologic agent. Conclusions: The response rate was higher than previously reported and might be due to higher infliximab dosing with shorter infusion intervals than standard dosing.

Current Role of Monoclonal Antibody Therapy in Pediatric IBD: A Special Focus on Therapeutic Drug Monitoring and Treat-to-Target Strategies

“…A meta-analysis by the ESPGHAN-IBD working group suggests that a higher dose per kilogram of body weight may be appropriate in younger IBD patients, as they often have lower trough levels in the early phase of therapy induction [ 51 ]. Indeed, a retrospective British study demonstrated that children with very early onset IBD received the increased dose of 10 mg/kg body weight [ 40 ]. The remission rate in these patients was 62%; otherwise, the course of very young children with IBD treated with biologics appears to be similar to that of older patients [ 40 , 41 ].…”

“…Indeed, a retrospective British study demonstrated that children with very early onset IBD received the increased dose of 10 mg/kg body weight [ 40 ]. The remission rate in these patients was 62%; otherwise, the course of very young children with IBD treated with biologics appears to be similar to that of older patients [ 40 , 41 ]. In particular, studies in pediatric patients with ulcerative colitis and Crohn’s disease have shown that higher infliximab trough levels after induction predict remission one year after infliximab administration [ 52 , 53 ] (see also Table 2 ).…”

JPGN and the Year 2022

“…The long-term outcomes and time to progression to anti-TNF treatment in 89 very early onset-IBD patients were reviewed between January 2005 and December 2019 in a study from Canada (30). Median age at diagnosis was 3.8 years, 45.3% had Crohn disease, and 62.8% were males.…”