Treatment patterns of anti‐tumour necrosis factor‐alpha and prognosis of paediatric and adult‐onset inflammatory bowel disease in Korea: a nationwide population‐based study

Abstract

Summary Background The global prevalence of inflammatory bowel disease (IBD) is increasing. However, population‐level data are scarce for Asian populations. Aims To outline and compare paediatric and adult IBD incidence and prevalence data in Korea, describe prescription patterns, and analyse outcomes of anti‐tumour necrosis factor (anti‐TNF) use in a nationally representative cohort Methods IBD was identified based on the presence of Rare and Intractable Disease diagnosis codes for Crohn's disease (CD) and ulcerative colitis (UC). We calculated age‐based prevalence and incidence, and examined prescription patterns. We used a Cox proportional hazard model to calculate the hazard ratio (HR) for undergoing surgery. Results The prevalence of CD increased between 2006 and 2015, particularly among those aged 10–19 years (12.7–35.5 patients per 100,000 people). The use of anti‐TNF agents increased from 3.2% to 22.9% in paediatric CD patients. Early use of an anti‐TNF agent increased 25‐fold in CD patients. Further, CD patients aged 0–14 years were most likely to undergo fistulectomy (HR, 2.63; 95% confidence interval [CI], 1.73–3.97). Children with UC had a higher risk of undergoing surgery (HR, 3.01; 95% CI, 1.33–6.83) than adults. Early use of an anti‐TNF agent in CD patients was associated with lower odds of surgery than late‐stage use. Conclusion The prevalence of IBD has increased over time, especially among paediatric patients. Given the magnitude of paediatric IBD disease burden, a multi‐faceted approach is needed for early detection and vigilant monitoring to aim for better prognosis.

Editorial: trends in the epidemiology of inflammatory bowel disease in Korea – author's reply

“…I thank Dr. Burisch for his editorial, 1 which highlighted important findings of our data provided by the National Registry 2 . My co‐authors and I agree with his appraisal of the content of our article.…”

Editorial: trends in the epidemiology of inflammatory bowel disease in Korea

“…Choe and colleagues have reported on the incidence and prevalence of IBD in Korea between 2006 and 2015. 1 They also described the treatment patterns and surgery rates during that period using the Korean nationwide patient registry. The authors made several interesting observations.…”

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

“…In Crohn’s disease, early and effective use of TNF-α blockers also prevented the development of disease complications, for example, strictures or penetrating ulcerations and disease progression [ 28 ]. A Korean study revealed that early anti-TNF-α medication led to a lower risk of surgery during disease progression [ 30 ]. In another study, early admission of biologics significantly reduced the risk of penetrating complications but not stenosing complications [ 31 ].…”