TY - JOUR
T1 - The inexorable increase of biological exposure in paediatric Inflammatory Bowel Disease
T2 - a Scottish, population-based, longitudinal study
AU - Burgess, Christopher
AU - Jackson, Rebecca
AU - Chalmers, Iain
AU - Russell, Richard
AU - Hansen, Richard
AU - Scott, Gregor
AU - Henderson, Paul
AU - Wilson, David C
N1 - Funding Information:
This work was supported by an Edinburgh Children's Hospital Charity Research Fellowship award (to C.J.B) and by funding from Crohn's and Colitis UK (Edinburgh network) and a joint CORE (Guts UK) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Development Grant. RJ was supported by a Catherine McEwan Foundation IBD Clinical Research Fellowship. RH, PH & RKR are supported by NHS Research Scotland Career Researcher Fellowships.
Publisher Copyright:
© 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - Background: The use of biologics in paediatric-onset inflammatory bowel disease (PIBD) is rapidly changing. Aims: To identify the incidence and prevalence of biologic use within Scottish PIBD services, and to describe patient demographics and outcomes for those patients who required escalation of therapy beyond anti-tumour necrosis factor alpha (anti-TNFα) agents. Methods: We captured a nationwide cohort of prospectively identified patients less than 18 years of age with PIBD (A1 phenotype; diagnosed <17 years of age) within paediatric services over a 4.5-year period (1 January 2015–30 June 2019). All patients who received infliximab, adalimumab, vedolizumab or ustekinumab during the study period and/or received their first dose of these biologics were audited retrospectively. Results: Scotland-wide PIBD-prevalence cases increased from 554 to 644 over the study period. A total of 495 incident new-start biological therapies were commenced on 403 PIBD patients: 295 infliximab (60%), 161 adalimumab (32%), 24 vedolizumab (5%) and 15 ustekunumab (3%). The proportion of new-start biologics changed with infliximab initiation rates decreasing (87%–54%) while adalimumab (13%–31%), vedolizumab (0%–9%) and ustekinumab (0%–6%) all increased. The incidence rate (first dose of new biologic not including biosimilar switch) increased from 6.9% to 8.1% over the study period and point prevalence rates (any biologic use) increased from 20.2% to 43.5% - an average annual percentage increase of 20%. Biosimilar penetration of new-start anti-TNFα agents increased from 3% to 91%. Demographics and outcomes of those patients receiving vedolizumab and ustekinumab were similar. Conclusions: Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing, inexorably increasing PIBD biologics landscape.
AB - Background: The use of biologics in paediatric-onset inflammatory bowel disease (PIBD) is rapidly changing. Aims: To identify the incidence and prevalence of biologic use within Scottish PIBD services, and to describe patient demographics and outcomes for those patients who required escalation of therapy beyond anti-tumour necrosis factor alpha (anti-TNFα) agents. Methods: We captured a nationwide cohort of prospectively identified patients less than 18 years of age with PIBD (A1 phenotype; diagnosed <17 years of age) within paediatric services over a 4.5-year period (1 January 2015–30 June 2019). All patients who received infliximab, adalimumab, vedolizumab or ustekinumab during the study period and/or received their first dose of these biologics were audited retrospectively. Results: Scotland-wide PIBD-prevalence cases increased from 554 to 644 over the study period. A total of 495 incident new-start biological therapies were commenced on 403 PIBD patients: 295 infliximab (60%), 161 adalimumab (32%), 24 vedolizumab (5%) and 15 ustekunumab (3%). The proportion of new-start biologics changed with infliximab initiation rates decreasing (87%–54%) while adalimumab (13%–31%), vedolizumab (0%–9%) and ustekinumab (0%–6%) all increased. The incidence rate (first dose of new biologic not including biosimilar switch) increased from 6.9% to 8.1% over the study period and point prevalence rates (any biologic use) increased from 20.2% to 43.5% - an average annual percentage increase of 20%. Biosimilar penetration of new-start anti-TNFα agents increased from 3% to 91%. Demographics and outcomes of those patients receiving vedolizumab and ustekinumab were similar. Conclusions: Complete accrual of Scottish nationwide biologic usage within paediatric services demonstrates a rapidly changing, inexorably increasing PIBD biologics landscape.
U2 - 10.1111/apt.17217
DO - 10.1111/apt.17217
M3 - Article
SN - 0269-2813
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
ER -