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Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood

Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood
Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood
Background: anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort were analysed for trends in anti-TNF-therapy and surgery.Design: all patients diagnosed with PIBD within Wessex from 1997-2017 were assessed. Prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson’s correlation, multivariate regression, Fisher’s exact).Results: eight-hundred-and-twenty-five children were included (498 Crohn’s disease, 272 ulcerative colitis, 55 IBD-unclassified), mean age at diagnosis 13.6 years (1.6-17.6), 39.6% female. Prevalence of anti-TNF-treated patients increased from 5.1% to 27.1% (2007-2017), p=0.0001. Surgical resection-rate fell (7.1% to 1.5%, p=0.001), driven by a decrease in Crohn’s disease resections (8.9% to 2.3%, p=0.001). Perianal surgery and ulcerative colitis resection-rates were unchanged. Time from diagnosis to resection increased (1.6 to 2.8 years, p=0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent five years (2007-2011=13.1 years, 2013-2017=11.9 years, p=0.014). Resection-rate in anti-TNF-therapy treated (16.1%) or untreated (12.2%) was no different (p=0.25). Patients started on anti-TNF-therapy <3 years post-diagnosis (11.6%) vs later (28.6%) had a reduction in resections, p=0.047. Anti-TNF-therapy prevalence was the only significant predictor of resection-rate using multivariate regression (p=0.011).Conclusion: the prevalence of anti-TNF-therapy increased significantly, alongside a decrease in surgical resection-rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti-TNF-therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.
0269-2813
398-407
Ashton, James J
03369017-99b5-40ae-9a43-14c98516f37d
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Mossotto, Enrico
a2a572db-3e95-41c6-94f6-f1b019594372
Coelho, Tracy, Antonio Francisco
83bbf944-8998-4f1f-ae32-ad2315bb5f8f
Batra, Akshay
822f891e-87ca-41d9-b68d-27c395e88809
Afzal, Nadeem A.
62505946-2503-42ba-9b02-85513bb3ec87
Phan, Hang Thi Thu
2811b94c-62b7-459d-9cc1-c88057008e3b
Stanton, Michael
eb3258f5-245b-454a-9556-9ef3d0ebb87d
Beattie, R. Mark
55d81c7b-08c9-4f42-b6d3-245869badb71
Ashton, James J
03369017-99b5-40ae-9a43-14c98516f37d
Borca, Florina
31fc3965-6bcf-4fd6-85bc-8b0f99f62473
Mossotto, Enrico
a2a572db-3e95-41c6-94f6-f1b019594372
Coelho, Tracy, Antonio Francisco
83bbf944-8998-4f1f-ae32-ad2315bb5f8f
Batra, Akshay
822f891e-87ca-41d9-b68d-27c395e88809
Afzal, Nadeem A.
62505946-2503-42ba-9b02-85513bb3ec87
Phan, Hang Thi Thu
2811b94c-62b7-459d-9cc1-c88057008e3b
Stanton, Michael
eb3258f5-245b-454a-9556-9ef3d0ebb87d
Beattie, R. Mark
55d81c7b-08c9-4f42-b6d3-245869badb71

Ashton, James J, Borca, Florina, Mossotto, Enrico, Coelho, Tracy, Antonio Francisco, Batra, Akshay, Afzal, Nadeem A., Phan, Hang Thi Thu, Stanton, Michael and Beattie, R. Mark (2019) Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood. Alimentary pharmacology & therapeutics, 49 (4), 398-407. (doi:10.1111/apt.15094).

Record type: Article

Abstract

Background: anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort were analysed for trends in anti-TNF-therapy and surgery.Design: all patients diagnosed with PIBD within Wessex from 1997-2017 were assessed. Prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson’s correlation, multivariate regression, Fisher’s exact).Results: eight-hundred-and-twenty-five children were included (498 Crohn’s disease, 272 ulcerative colitis, 55 IBD-unclassified), mean age at diagnosis 13.6 years (1.6-17.6), 39.6% female. Prevalence of anti-TNF-treated patients increased from 5.1% to 27.1% (2007-2017), p=0.0001. Surgical resection-rate fell (7.1% to 1.5%, p=0.001), driven by a decrease in Crohn’s disease resections (8.9% to 2.3%, p=0.001). Perianal surgery and ulcerative colitis resection-rates were unchanged. Time from diagnosis to resection increased (1.6 to 2.8 years, p=0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent five years (2007-2011=13.1 years, 2013-2017=11.9 years, p=0.014). Resection-rate in anti-TNF-therapy treated (16.1%) or untreated (12.2%) was no different (p=0.25). Patients started on anti-TNF-therapy <3 years post-diagnosis (11.6%) vs later (28.6%) had a reduction in resections, p=0.047. Anti-TNF-therapy prevalence was the only significant predictor of resection-rate using multivariate regression (p=0.011).Conclusion: the prevalence of anti-TNF-therapy increased significantly, alongside a decrease in surgical resection-rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti-TNF-therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.

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JJA RMB 20 11 18 Increased prevalence of anti-TNF therapy - Accepted Manuscript
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Accepted/In Press date: 22 November 2018
e-pub ahead of print date: 9 January 2019
Published date: 1 February 2019

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Local EPrints ID: 426518
URI: https://eprints.soton.ac.uk/id/eprint/426518
ISSN: 0269-2813
PURE UUID: 29bc0ae7-fd28-4f1d-811b-8dfdeff57f81

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Date deposited: 29 Nov 2018 17:30
Last modified: 13 Mar 2019 17:47

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