The following is a summary of “New Therapeutic Strategies Are Associated With a Significant Decrease in Colectomy Rate in Pediatric Ulcerative Colitis,” published in the November 2023 issue of Gastroenterology by Ley, et al.
For a study, researchers sought to assess the impact of introducing immunosuppressants (IS) and anti-tumor necrosis factor (TNF) on the long-term outcomes of pediatric ulcerative colitis (UC) using a large population-based cohort.
A retrospective follow-up of pediatric UC patients from the EPIMAD registry, diagnosed between 1988 and 2011, was conducted until 2013. Patients were categorized into three diagnostic periods: 1988 to 1993 (pre-IS era), 1994 to 2000 (pre-anti-TNF era), and 2001 to 2011 (anti-TNF era). Medication exposure and disease outcomes, including colectomy rates, were compared across these periods.
A total of 337 pediatric UC patients were followed for a median duration of 7.2 years. The exposure rates to IS and anti-TNF at 5 years increased over time from 7.8% (P1) to 63.8% (P3) and from 0% (P1) to 37.2% (P3), respectively. The risk of colectomy at 5 years significantly decreased from 17% (P1) to 9% (P3) P = 0.045, P-trend = 0.027, with a notable decline observed between pre-anti-TNF (P1 + P2, 18%) and anti-TNF era (P3, 9%) (P = 0.013). The risk of disease extension at 5 years remained stable over time (P1, 36%; P2, 32%; P3, 34% P = 0.31, P-trend = 0.52), and between the pre-anti-TNF era (P1 + P2, 34%) and the anti-TNF era (P3, 34%) (P = 0.92). The risk of flare-related hospitalization at 5 years significantly increased over time (P1, 16%; P2, 27%; P3, 42% P = 0.0012, P-trend = 0.000) and between the pre-anti-TNF era (P1 + P2, 23%) and the anti-TNF era (P3, 42%) (P = 0.0004).
The study revealed a substantial decline in the risk of colectomy in pediatric UC patients parallel to the increased use of IS and anti-TNF therapies, indicating a positive impact of these treatments at the population level.