Pediatric IBD Rates Increasing Throughout the World


There remains a paucity of data for very early onset pediatric IBD in the majority of countries.

M. Ellen Kuenzig, PhD

M. Ellen Kuenzig, PhD

Pediatric inflammatory bowel disease (IBD) rates are increasing throughout the world since the turn of the century.

A team, led by M. Ellen Kuenzig, SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, reviewed the global trends in incidence and prevalence of IBD diagnosed under the age of 21 years since 2000.

Increasing Rates

Internationally, IBD rates are increasing, especially in nations with historically low rates of the disease. However, there is not much data available of the epidemiology of pediatric-onset IBD.

In the study, the investigators examined various databases between January 2010 and February 2020 to identify population-based studies reporting on the incidence or prevalence of IBD, Crohn’s disease, ulcerative colitis, or unclassified IBD.

The team also used data from studies published prior to 2000 from a previously published systematic review.

Geographic Trends

Using this data, the investigators described the geographic distribution and trends in children for all ages and limiting to very early onset IBD.

Overall, they identified 131 studies from 48 countries and found the incidence and prevalence of pediatric-onset IBD is highest in Northern Europe and North America.

On the other hand, the prevalence of the disease is at the lowest in Southern Europe, Asia, and the Middle East.

The investigators also looked at different trends that can be derived from the data. Here they found 84% (n = 31) of studies reported significant increases in incidence and all 7 studies reported significant increases in prevalence.

However, there was some limitations in the data.

For example, the data on the incidence and prevalence of very early onset IBD was limited to countries with historically high rates of IBD and time trends in the incidence of very early onset IBD were visually heterogeneous.

“Rates of pediatric-onset IBD continue to rise around the world and data are emerging from regions where it was not previously reported,” the authors wrote. “However, there remains a paucity of data on [very early onset] IBD and on pediatric IBD from developing and recently developed countries.

A Treatment Option

One potential option for pediatric patients with IBD might be adalimumab (Humira).

Last year, adalimumab was approved by the US Food and Drug Administration (FDA) for the treatment of moderate to severe ulcerative colitis in patients ≥5 years of age.

The tumor necrosis factor (TNF) inhibitor was shown to lead to clinical remission in patients at various dosing levels. Even more, the drug was considered to be safe and well-tolerated in the patient population.

In an interview with HCPLive®, Marla Dubinsky, MD, of Icahn School of Medicine at Mount Sinai discussed the implications of this approval for pediatric treatment strategies.

“Options are always good. It’s not one size fits all,” she said, noting the drug’s similarity to infliximab (Remicade), another biologic that was approved for pediatric ulcerative colitis in 2011. Infliximab likewise targets TNF.

However, Dubinsky explained that such patients who have used infliximab but have failed to respond to treatment now have an option in adalimumab. And yet, this switch can happen both ways.

“It’s not that it’s linear in one direction or another,” she said. “However, I think what this shows is that if we can get more patients access to early effective therapies­—whether it is infliximab or adalimumab—then that is the key message.”

The study, “Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review,” was published online in Gastroenterology.

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