Rapid Progression to Biologics Linked to Disease Severity in Very Early Onset IBD

Very early onset inflammatory bowel disease (IBD) with the associated biologic therapy is linked to an increased risk of Perianal fistulizing disease or structuring disease, but also a higher response rate.

A team, led by Adi Eindor-Abarbanel, Department of Pediatrics, BC Children’s Hospital, assessed the long-term outcomes and time to progress of anti-TNF treatment in patients with very early onset IBD.

Anti-TNF

There is limited data on anti-TNF use and outcomes in patients with very early onset IBD.

In the study, the investigators retrospectively review patients with IBD diagnosed under 6 years between January 2005 and December 2019 from the British-Columbia (BC) Pediatric IBD database and documented demographic data, disease characteristics, disease location, and severity.

Other information collected included data on anti-TNF treatment at initiation and during following, such as type of biologic, dosing, and response. They also used Kaplan Meier curves to assess the number of years to progression to anti-TNF treatment and the parameters influencing commencement.

Pediatric Patients

There was a total of 89 pediatric patients with vert early onset IBD included in the study, with a median age at diagnosis of 3.8 years. In addition, 45.3% of the patients had Crohn’s disease and 62.8% were male.

Anti-TNF therapy was started in 39.5% of patients, while 7.0% of the patients underwent surgery.

The investigators found rapid progression to biologic treatment was linked to Perianal fistulizing disease (P = 0.026) or structuring disease (P = 0.033) in patients with Crohn’s disease. Rapid progression to biologic treatment was also linked to disease severity (P = 0.017) in patients with ulcerative colitis.

The median dose of infliximab at 1 year was 10 mg/kg, with a median dose interval of 4.5 weeks.

Overall, 61.8% of patients on their first biologic agent reported clinical remission.

“The response rate was higher than previously reported and might be due to higher Infliximab dosing with shorter infusion intervals than standard dosing,” the authors wrote.

Pediatric IBD Rates

Pediatric IBD rates are increasing throughout the world since the turn of the century.

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.

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.

The study, “Progression to anti-TNF treatment in very early onset inflammatory bowel disease patients,” was published online in the Journal of Pediatric Gastroenterology and Nutrition.