Use, Durability, and Risks for Discontinuation of Initial and Subsequent Biologics in a Large Pediatric-Onset IBD Cohort. Issue 5 (19th February 2023)

• Record Type: Journal Article
• Authors: Kaplan, Jess L.; Liu, Chunyan; King, Eileen C.; Bass, Julie A.; Patel, Ashish S.; Tung, Jeanne; Chen, Shiran; Lissoos, Trevor; Candela, Ninfa; Saeed, Shehzad; Colletti, Richard B.
• Other Names: Adler Jeremy author non-byline.; Baron Howard I. author non-byline.; Cabrera José M. author non-byline.; Dorsey Jill M. author non-byline.; Dykes Dana M.H. author non-byline.; Ebach Dawn R. author non-byline.; Garin-Laflam Monica P. author non-byline.; Gold Benjamin D. author non-byline.; Grunow John author non-byline.; Higuchi Leslie M. author non-byline.; Jester Traci W. author non-byline.; Lapsia Sameer P. author non-byline.; Leibowitz Ian author non-byline.; Linvlle Tiffany M. author non-byline.; Morhardt Tina L. author non-byline.; Moses Jonathan author non-byline.; Moulton Dedrick author non-byline.; Nasiri-Blomgren Shaida author non-byline.; Niklinska-Schirtz B. Joanna author non-byline.; Ogunmola Nicholas A. author non-byline.; Palomo Pablo J. author non-byline.; Park K.T. author non-byline.; Pashankar Dinesh S. author non-byline.; Pasternak Brad A. author non-byline.; Radano Marcella C. author non-byline.; Samson Charles M. author non-byline.; Sandberg Kelly C. author non-byline.; Schaefer Marc E. author non-byline.; Shashidhar Harohalli author non-byline.; Steiner Steven J. author non-byline.; Sullivan Jillian S. author non-byline.; Tomer Gitit author non-byline.; Verstraete Sophia G. author non-byline.;
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 76:Issue 5(2023)
• Page Start: 566
• Page End: 575
• Publication Date: 2023-02-19
• Subjects: Crohn disease -- persistence -- real-world evidence -- ulcerative colitis; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000003734
• Languages: English
• ISSNs: 0277-2116

Abstract

Abstract : Background: Biologic medications are recommended for treatment of moderately-to-severely active Crohn disease (CD) or ulcerative colitis (UC) in children. However, many patients require sequential biologic treatment because of nonresponse or loss of response to the initial biologic. Methods: We analyzed pediatric inflammatory bowel disease (IBD) data from the ImproveCareNow Network registry between May 2006 and September 2016, including time to biologic initiation, choice of first subsequent biologics, biologic durability, and reasons for discontinuation. Results: Of 17, 649 patients with IBD [CD: 12, 410 (70%); UC: 5239 (30%)], 7585 (43%) were treated with a biologic agent before age 18 (CD: 50%; UC: 25%). Biologic treatment was more likely for CD than UC (odds ratio, 3.0; 95% CI: 2.8–3.2; P < 0.0001). First biologic agents for all patients were anti-tumor necrosis factor agents (88% infliximab, 12% adalimumab). Probability of remaining on the first biologic was significantly higher in CD than UC ( P < 0.0001). First biologics were discontinued because of loss of response (39%), intolerance (23%), and nonresponse (19%). In univariate analysis, factors associated with discontinuation of first and/or second biologics in CD include colonic-only disease, corticosteroid use, upper gastrointestinal tract involvement, and clinical and biochemical markers of severe disease. Biologic durability improved with later induction date. Conclusions: Treatment with biologic medications is common in pediatric IBD. Patients with CD are more likely to receive biologics, receive biologics earlier in disease course, and remain on the first biologic longer than patients with UC. Multiple factors may predict biologic durability in children with IBD. Abstract :