Variation in Infliximab Administration Practices in the Treatment of Pediatric Inflammatory Bowel Disease

Adler, Jeremy; Sandberg, Kelly C.; Shpeen, Benjamin; Eder, Sally J.; Dhanani, Muhammad; Clark, Sarah J.; Freed, Gary L.

doi:10.1097/mpg.0b013e31828f1ea2

Cited by 27 publications

(24 citation statements)

References 10 publications

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“…Our investigation represents the largest and most representative sample of clinician participants managing IBD across various practice types, including both adult and pediatric gastroenterologists. The findings presented corroborate a previous study, 20 which focused on the variability of infliximab administration practices among pediatric gastroenterologists.…”

Section: Discussionsupporting

confidence: 90%

Premedication Use Before Infliximab Administration

Picoraro

Winberry

Siegel

et al. 2017

Inflammatory Bowel Diseases

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Background Premedications are commonly given to inflammatory bowel disease (IBD) patients prior to intravenous infliximab administration. We aimed to (1) describe practice variability; and (2) determine clinician rationale for premedicating IBD patients prior to infliximab administration. Methods We developed a cross-sectional electronic survey after comprehensive literature review to assess practice variability and clinician rationale for premedication use prior to infliximab. An optional post-survey quiz assessed clinicians’ understanding of available literature. The survey was distributed through members-only NASPGHAN and Crohn’s and Colitis Foundation of America (CCFA) listservs and American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) web-based discussion boards. Results 379 unique respondents with a 93.3% survey completion rate comprised 331 (87%) and 45 (12%) pediatric and adult gastroenterologists. Among numerous options for premedications, acetaminophen (66%) and diphenhydramine (64%) were most often given prior to each infliximab infusion. Only 20% did not routinely use premedications. There was heterogeneity of premedication use between gastroenterologists within the same clinical practice. Of 328 (87%) respondents who completed the knowledge assessment quiz, only 18% identified the association of diphenhydramine use with increased reaction. Conclusion There is high inter- and intra-practice variability for premedication use prior to infliximab administration. Clinician rationale for premedicating patients appears to be driven by individual preference or group practice habit. Improved knowledge of the evidence may assist in decreasing over-use of premedications, particularly diphenhydramine.

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Section: Discussionsupporting

confidence: 90%

Premedication Use Before Infliximab Administration

Picoraro

Winberry

Siegel

et al. 2017

Inflammatory Bowel Diseases

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“…Adler et al . observed a wide variation in the practice of infliximab administration among 207 pediatric IBD practitioners in the USA . Bilal et al .…”

Section: Discussionmentioning

confidence: 99%

Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

Han

Jung

Cheon

et al. 2019

J of Gastro and Hepatol

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Background and Aim Variation in medical care can be an obstacle to improving quality and outcome of treatment. We conducted a nationwide, population‐based study to identify regional variations in medication prescription rates in Korean patients with inflammatory bowel diseases (IBDs). Methods Using the National Health Insurance claims, we collected data on patients diagnosed with IBD (8974 cases of Crohn's disease [CD] and 17 167 cases of ulcerative colitis [UC]) between 2010 and 2016. Results Overall rates of biologics (infliximab or adalimumab) use in CD and UC were 19.6% and 6.1%, respectively, and those of immunomodulator (azathioprine or 6‐mercaptopurine) use were 66.9% and 20.4%, respectively. The average periods from diagnosis to first biologics use for CD and UC were 1.6 and 1.8 years, respectively, and those of immunomodulators were 0.6 and 1.3 years, respectively. In Seoul, Daegu, and Busan, three major cities in Korea, biologics prescription rates for CD were 20.7%, 22.9%, and 14.6%, respectively, and those for UC were 7.3%, 6.7%, and 4.5%, respectively. In the top 7 regions with the highest number of patients in Seoul, there were 3.6‐fold and 3.2‐fold variations between regions with the highest and lowest frequency of biologics use in CD and UC, respectively. In addition, there were 1.6‐fold and 2.8‐fold variations between regions with the highest and lowest frequency of immunomodulator use for CD and UC, respectively. Conclusions Regional variation exists in medication prescription rates within a single city as well as nationwide, suggesting that standardization of IBD treatment is necessary in Korea.

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“…Other studies considered surgical rates at a population level; work from Rungoe et al comparing two cohorts 1979‐1986 and 2003‐2011) demonstrating a significant reduction in surgical rates for both Crohn's disease and ulcerative colitis paralleled by an increase in anti‐TNF medication . However Lazarev et al did not find a reduction in small bowel resection rates over time in adults with Crohn's disease, despite increased anti‐TNF use . The recent “Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease” (LIRIC) trial in adults, comparing outcomes after randomised escalation to either anti‐TNF therapy or limited ileocaecal resection in Crohn's disease, concluded that surgical resection remained a viable alternative to medical therapy .…”

Section: Introductionmentioning

confidence: 99%

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

Ashton

Borca

Mossotto

et al. 2019

Aliment Pharmacol Ther

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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.

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Variation in Infliximab Administration Practices in the Treatment of Pediatric Inflammatory Bowel Disease

Abstract: Wide variation exists in the practice of infliximab administration in pediatric IBD. The effect of these variations on outcomes is unknown.

Cited by 27 publications

References 10 publications

Premedication Use Before Infliximab Administration

Premedication Use Before Infliximab Administration

Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

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

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