Merrick VM, et al. - Researchers analyzed the effectiveness, safety, and use of anti-tumor necrosis factor (TNF) therapy in pediatric inflammatory bowel disease in the United Kingdom (UK). They revealed that anti-TNFs were effective treatments, usually given with thiopurine co-immunosuppression. Findings underscored deficiencies in formal documentation of effect and disparity between disease severity scoring tools, which ought to be addressed to improve ongoing patient care.

Methods

• This study included prospective UK audit of patients newly starting anti-TNF therapy.
• The researchers evaluated disease severity using Physician Global Assessment +/or the Paediatric Crohn Disease Activity Index.

Results

• Thirty-seven centers participated (23/25 specialist pediatric inflammatory bowel disease sites).
• The researchers included 524 patients [429 with Crohn's disease (CD), 76 with ulcerative colitis (UC), and 19 with IBD unclassified (IBDU)].
• In this study, 87% (488/562) of anti-TNF was infliximab; commonest indication was active luminal CD 77% (330/429) or chronic refractory UC/IBDU 56% (53/95); 79% (445/562) had concomitant co-immunosuppression.
• Median time from diagnosis to treatment in CD (267/429 male) was 1.42 years (interquartile range 0.63–2.97).
• At initiation, disease was moderate or severe in 91% (156/171) by Physician Global Assessment compared to 41% (88/217) by Paediatric Crohn Disease Activity Index (Kappa (κ) 0.28 = only “fair agreement”; P < 0.001.
• Where documented, seventy-seven percent (53/69) of patients with CD responded to induction, and 65% (46/71) entered remission.
• A total of 2287 infusions and 301.96 years of patient’ follow-up (n = 385) are represented.
• Adverse events affected 3% (49/1587) infliximab and 2% (2/98) adalimumab infusions (no deaths or malignancies).
• After anti-TNF initiation (CD), peri-anal abscess drainage was less common, that was found to be 26% (27/102) before, 7% (3/42) after (P=0.01).
• However, pre and post anti-TNF data collection was not over equal time periods.