Insight into immunomodulator and biologic use by patients with inflammatory bowel disease might reveal differences between childhood- and adult-onset disease, according to research published in Alimentary Pharmacology & Therapeutics.
“The major peak incidence of IBD occurs at the onset of adulthood, although an increased incidence of IBD at pediatric age has recently been reported,” María Chaparro, MD, PhD, of the IBD Unit at University Hospital La Princesa in Spain, and colleagues wrote. “It has been suggested that childhoodonset IBD may be a different entity, more severe and ‘aggressive’ than IBD diagnosed at adulthood, and that genetic factors could play a more important role in children than in adults, although in adults with older age at onset and more advanced IBD, environmental factors would play a more prominent role.”
Researchers compared disease characteristics, as well as differences in immunomodulator use, biologic use and surgery rates using data from the ENEIDA registry. The study comprised 21,200 patients diagnosed with IBD between 2007 and 2017. Investigators separated patients into two groups; childhood-onset IBD (diagnosed at 16 years or younger; n = 846), and adult-onset IBD (diagnosed older than 16 years; n = 20,354).
After adjusting for sex, type of IBD, extraintestinal manifestations, family history and smoking habit, researchers found that childhood-onset IBD was associated with higher risk for immunomodulator use (HR = 1.2; 95% CI, 1.1–1.2) and higher probability of receiving biologic treatment (HR = 1.2; 95% CI, 1.1–1.3). There were also higher proportions of Crohn’s disease, ileocolonic involvement and inflammatory behavior at diagnosis in the childhood-onset group.
Despite these differences, childhood-onset IBD was not associated with higher risk for surgery.
“The use of immunomodulators and biologic agents is higher in childhoodonset patients, suggesting a more aggressive course of the disease,” Chaparro and colleagues wrote. “Despite the higher burden of the disease in children, the rate of surgery is similar in this population in comparison with adulthood-onset IBD.” – by Alex Young
Disclosures: Chaparro reports serving as speaker for or receiving research or education funding from AbbVie, Dr. Falk Pharma, Ferring, Hospira, Janssen, MSD, Pfizer, Shire Pharmaceuticals, Takeda and Tillotts Pharma. Please see the full study for all other authors’ relevant financial disclosures.