Pediatric IBD: increasing TNFi use accompanied by dropping resection rates

  • Ashton JJ & al.
  • Aliment Pharmacol Ther
  • 9 Jan 2019

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In children with IBD, the prevalence of TNF inhibitor (TNFi) therapy increased 5-fold over a decade (2007-2017) while the surgical resection rate fell from 7% to 1.5%.
  • TNFi prevalence per year was the only factor associated with fewer surgical resections.

Why this matters

  • TNFi therapy may be modifying the natural history of pediatric IBD.

Study design

  • Retrospective cohort of 825 children
  • Funding: None disclosed.

Key results

  • Mean age at diagnosis was 13.6 years.
  • From 2007 to 2017, the prevalence of TNFi-treated patients rose from 5.05% to 27.1% (P=.0001) while the surgical resection rate fell from 7.07% to 1.46% (P=.001).
  • On multivariate analysis, TNFi prevalence per year was the only factor associated with fewer surgical resections (P=.011).
  • The reduction in surgical resections was driven by patients with Crohn's disease (8.9%-2.3%; P=.001), but not ulcerative colitis.
  • There was no decline in rate of perianal surgeries.
  • Time from diagnosis to resection rose from 1.64 to 2.78 years (P=.002), but there was no change in mean age at resection.

Limitations

  • Retrospective observational design.

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