Real-Life Anti-Tumour Necrosis Factor Experience in > 500 Paediatric United Kingdom Inflammatory Bowel Disease Patients

Victoria M Merrick, Kajal Mortier, Linda Williams, Rafeeq Muhammed, Marcus Kh Auth, Mamoun Elawad, John Me Fell, R Mark Beattie, Sabarinathan Loganathan, Franco Torrente, Mary-anne Morris, Charles Charlton, Nick M Croft, Astor Rodrigues, Mark Furman, Babu Vadamalayan, Huw Jenkins, Veena Zamvar, Sally G Mitton, Sonny ChongMike Cosgrove, Anthony Akobeng, David Wilson, Richard K Russell

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: The aim of this study was to measure the effectiveness, safety, and use of anti-tumor necrosis Factor (TNF) therapy in pediatric inflammatory bowel disease in the United Kingdom (UK).

METHODS: Prospective UK audit of patients newly starting anti-TNF therapy. Disease severity was assessed using Physician Global Assessment +/or the Paediatric Crohn Disease Activity Index.

RESULTS: A total of 37 centers participated (23/25 specialist pediatric inflammatory bowel disease sites). A total of 524 patients were included: 429 with Crohn disease (CD), 76 with ulcerative colitis (UC), and 19 with IBD unclassified (IBDU). Eighty-seven percent (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. In CD (267/429 male), median time from diagnosis to treatment was 1.42 years (interquartile range 0.63-2.97). Disease (at initiation) 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, 77% (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). Peri-anal abscess drainage was less common after anti-TNF initiation (CD), that is 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.

CONCLUSIONS: Anti-TNFs are effective treatments, usually given with thiopurine co-immunosuppression. This study highlights deficiencies in formal documentation of effect and disparity between disease severity scoring tools, which need to be addressed to improve ongoing patient care.

Original languageEnglish
Pages (from-to)274-280
Number of pages7
JournalJournal of pediatric gastroenterology and nutrition
Volume66
Issue number2
Early online date27 Jul 2017
DOIs
Publication statusPublished - Feb 2018

Keywords

  • Paediatric gastroenterology
  • Inflammatory Bowel Disease
  • Crohn’s disease
  • ulcerative colitis
  • biologics (IBD)

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