Since anti-TNF alpha therapy for inflammatory bowel disease was introduced, there has been a significant drop in surgical resections in pediatric patients, according to research published in Alimentary Pharmacology & Therapeutics.
Robert Mark Beattie, FRCPCH, MRCP, MBBS, BSc, of the department of pediatric gastroenterology at Southampton Children’s Hospital in the United Kingdom, and colleagues wrote that there has been a rapid increase in the use of anti-TNF over the last 15 years resulting in better symptom control and intestinal healing among patients.
“The longterm impact of anti-TNF medications on the rates of surgery before transition to adult services in pediatric IBD is uncertain,” they wrote. “Previous data appear to suggest that anti-TNF therapy delays but not avoids the need for surgery in childhood.”
Researchers analyzed data from patients diagnosed with pediatric IBD in the Wessex region of the U.K. between 1997 and 2017 (n = 825; Crohn’s disease, n = 498; ulcerative colitis, n = 272; unclassified IBD, n = 55). They explored the prevalence of anti-TNF therapy and yearly surgery rates during childhood (younger than 18 years).
Over the course of 20 years, the prevalence of anti-TNF treated patients increased from 5.1% to 27.1% (P = .0001). During that same period, the surgical resection rate in patients with pediatric IBD decreased from 7.1% to 1.5% (P = .001), driven by a decrease in CD resections (8.9% to 2.3%; P = .001). Rates for perianal surgery and UC-related resection went unchanged.
Although the mean age at resection did not change, time from diagnosis to resection increased (1.6 to 2.8 years; P = .028), and patients that had to undergo resection were diagnosed at a younger age in the five most recent years of the analysis (2007-2011 = 13.1 years; 2013-2017 = 11.9 years; P = .014).
“These data suggest that anti-TNF therapy may be modifying the natural history of IBD in childhood,” Ashton and colleagues wrote. “Progression to personalizing therapy within pediatric IBD now appears to be the next major challenge, balancing which patients would benefit from early introduction of anti-TNF therapy and those where an expectant approach can be adopted.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.