Anti-TNF decreases risk for penetrating complication in pediatric Crohn’s
Among pediatric patients with Crohn’s disease and ulcerative colitis, the risk for incidence of intestinal resection and colectomy after 5 years of diagnosis decreased over a 24-year period, according to a presenter at UEG Week.
“The aim of the present study was to gain more insight into the impacts of immunosuppressants and anti-tumor necrosis introduction on long-term disease outcomes in a large, population-based pediatric cohort,” Delphine Ley, MD, PhD, of the INSERM unit at the University of Lille and the department of pediatrics at Lille University Hospital in France, said.
Researchers analyzed 1,322 patients (48% girls; < 17 years) from the INSPIRED cohort diagnosed with Crohn’s disease (CD, n = 1,007) or ulcerative colitis (UC, n = 337) between 1998 and 2011 with retrospective follow-up until 2013. Between the diagnostic periods of 1988 to 1993 (P1: pre-immunosuppressant era), 1994 to 2000 (P2: pre-anti-TNF era) and 2001 to 2011 (P3: anti-TNF era), they compared intestinal resection rate, hospitalization and behavior progression.
During a median follow-up of 8.8 years among patients with CD, researchers observed an increase in 5-year exposure rates from P1 to P3 for both immunosuppressants (33.9% vs. 76.5%) and anti-TNFs (0% vs. 50.5%) as well as a decrease in the risk for intestinal resection at all time points (35% vs. 31% vs. 22%); this decrease correlated with exposure to immunosuppressants (HR = 0.36; 95% CI, 0.23-0.56) and anti-TNFs (HR = 0.34; 95% CI, 0.19-0.61). The risk for IBD flare-related hospitalization did not change over time (31% vs. 30% vs. 29%).
Similarly, during a median follow-up of 7.2 years among patients with UC, the 5-year exposure rates also increased for immunosuppressants (7.8% vs. 63.8%) and anti-TNFs (0% vs. 37.2%) while the risk for colectomy decreased over time (17% vs. 19% vs. 9%). This decrease did not correlate with exposure to immunosuppressants (HR = 0.3; 95% CI, 0.07-1.34) or anti-TNFs (HR = 0.38; 95% CI, 0.05-2.92). The risk for IBD flare-related hospitalization increased (16% vs. 27% vs. 42%).
Overall, in univariate analysis, researchers noted a lower risk for progression from inflammatory behavior to penetrating behavior in anti-TNF exposed patients (HR = 0.43; 95% CI, 0.19-0.94) compared with immunosuppressant exposed patients (HR = 0.93; 95% CI, 0.51-1.71).
“This is the largest pediatric population-based cohort evaluating the impact of therapeutic strategies over a 24-year period. In parallel with the increased use of immunosuppressant and anti-TNF, positive changes in the natural history of Crohn’s disease were observed at the population level,” Ley concluded. “Anti-TNF exposure was associated with a decreased risk for both intestinal resection and penetrating complication in CD.”