Unlike adults, children with inflammatory bowel disease who undergo anti-tumor necrosis factor therapy may not be at increased risk for infection, according to study results.
“The safety evidence of TNF-alpha inhibitor use in children with IBD is scarce,” Viktor Wintzell, MSc, of the clinical epidemiology division at Karolinska Institutet in Stockholm, and colleagues wrote. “As a result of the concerns regarding the risk of serious infection, more data are needed to support clinical practice and decisions about optimal treatment strategies in children.”
To find out whether the risk seen in adults also applies to younger patients, researchers analyzed data from health registers and identified episodes of children and adolescents (age < 18 years) with at least two recorded IBD diagnoses in specialist care. Using specialist care records, they categorized mutually exclusive episodes of incident anti-TNF use (no previous use in the last year) or no anti-TNF use.
The primary outcome of the study was serious infections, defined as infection requiring a hospital stay, which researchers identified though hospital records. They compared hazard ratios after adjusting for demographics, comorbidities, treatment history, health care use and indicators of disease severity.
In the 2,817 patients included in the analysis, Wintzell and colleagues identified 618 episodes of incident anti-TNF use and 2,925 episodes of no anti-TNF use.
During follow-up (median, 1.4 years), the cohort exposed to anti-TNF had a weighted incidence of serious infection of 54.6 events per 1,000 patient-years, whereas the nonexposed group experienced 61.9 events per 1,000 patient years. Investigators also determined that the weighted hazard ratio of serious infection associated with anti-TNF use was 0.81 (95% CI, 0.54-1.21).
“Together with previous findings, the results suggest that TNF-alpha inhibitor use might not be associated with an increased risk of serious infection in children, contrary to findings in adults,” Wintzell and colleagues wrote. “However, more studies from other settings and with larger samples of TNF-alpha inhibitor users need to be done to clarify the potential differences between age groups and further investigate the risk of site-specific infections.” – by Alex Young
Disclosures: Wintzell reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.