IBD Journal Scan
Key articles from high impact journals in last month
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Anti-TNF Therapy in Pediatric IBD: High Failure Rates Within 5 Years
Anti-TNF agents are commonly used to treat inflammatory bowel disease (IBD), yet their long-term success in pediatric cases remains uncertain. In a study tracking 1,344 patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before age 17, researchers found that about 60% of CD and 70% of UC patients experienced anti-TNF therapy failure within 5 years, with loss of response (LOR) being the primary cause. The failure risk was highest during the first year of treatment. Factors like female gender and early initiation of anti-TNF were linked to increased failure rates. In contrast, no deaths or serious complications such as cancer or tuberculosis occurred during treatment. These findings highlight the need for improved long-term management strategies for pediatric-onset IBD.
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Early Anti-TNF Treatment in Pediatric Crohn's Disease May Lower Complications and Surgery Risk
A study analyzing 5-year outcomes in 1,075 children newly diagnosed with Crohn's disease (CD) reveals a critical insight: early anti-tumor necrosis factor (aTNF) therapy can reduce the progression to stricturing disease and surgery. Researchers observed a rise in stricturing complications from 2.98% to 10.60% over the study period. However, anti-TNF exposure within three months of diagnosis decreased the progression from inflammatory to stricturing CD behavior. Children with low body mass index z-scores (BMIz) at diagnosis had a reduced risk of surgery if their BMIz normalized within six months. A proinflammatory transcriptomic profile was associated with those who did not achieve BMIz normalization. Additionally, early treatment with 5-aminosalicyclic acid was linked to a lower surgery risk. These findings suggest that prompt aTNF treatment and BMIz normalization can play a significant role in mitigating severe outcomes in pediatric CD.
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Biological Therapy in Pediatric IBD: Does It Curb Surgery Risk?
Inflammatory bowel disease (IBD) in children often takes a more aggressive course than in adults. This study explored whether biological treatment started in childhood reduces the need for intestinal surgery as patients transition to adulthood. A retrospective analysis of 207 pediatric IBD patients, treated with biological therapy at a single center, was conducted to determine the rate of surgeries over time. With a median follow-up of 9 years, 32.9% of the patients required intestinal surgery—49 with Crohn's disease (CD), 13 with ulcerative colitis (UC), and 6 with IBD unclassified (IBDU). While patients who had surgery in childhood were at higher risk for additional surgeries in early adulthood, the duration of the disease at the first biological treatment was the key risk factor. Despite biological therapy, the risk of intestinal surgery remains significant for pediatric IBD patients, often materializing after transitioning to adult care.
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Ustekinumab Shows Promise in Treating Pediatric Crohn's Disease: Study Finds High Remission Rates and Safety in Chaina
Ustekinumab (UST), approved for treating Crohn's disease (CD) in adults, is seeing increased off-label use among pediatric patients. A recent multicenter retrospective study across three tertiary care centers evaluated UST's safety and effectiveness in children and adolescents with CD. Sixteen patients who began UST before age 18 and were followed for at least 24 weeks were included in the study. Clinical remission was achieved by 41.7% of patients at weeks 24-32 and by 75% at weeks 48-56, with significant reductions in the Weighted Pediatric CD Activity Index (wPCDAI). Five of eleven children also achieved endoscopic remission. Remarkably, no serious adverse events were observed during the study period. The results suggest that UST could be an effective option for inducing or maintaining remission in pediatric CD, providing a new therapeutic avenue for children and adolescents with this challenging condition.
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Vedolizumab Effective and Safe for Pediatric IBD: 14-Week Results from the VEDOKIDS Study
The use of vedolizumab, a biologic therapy for inflammatory bowel disease (IBD), in children has lacked extensive data. The VEDOKIDS study, a multicenter prospective cohort study conducted across 17 centers in six countries, examined the safety and effectiveness of vedolizumab in inducing remission in pediatric IBD patients. This initial analysis reports the 14-week outcomes from a planned 3-year follow-up study.
A total of 142 children with IBD were followed at baseline, 2, 6, and 14 weeks. Vedolizumab was administered based on local practices, with a recommended dose of 177 mg/m² body surface area, capped at 300 mg. At 14 weeks, 42% of children with ulcerative colitis and 32% with Crohn's disease achieved steroid-free and enteral nutrition-free remission. Vedolizumab was generally well-tolerated, with no severe adverse events recorded and only two patients discontinuing treatment due to adverse events. The optimal drug concentration for children under 30 kg was identified as 7 μg/mL, suggesting dosing should consider body surface area or weight. These results indicate vedolizumab's potential for safely inducing remission in children with IBD, particularly those with ulcerative colitis, and offer guidance on optimal dosing for younger patients.
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Dual Biologic Therapy Shows Promise in Treating Refractory Pediatric IBD but Carries Risk of Adverse Events
Dual biologic therapy might offer a new lifeline for children with refractory inflammatory bowel disease (IBD), according to a recent multicenter study. Conducted across 14 centers affiliated with the Pediatric IBD Interest and Porto Groups of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition, the study examined the safety and effectiveness of dual therapy in pediatric IBD patients.
The retrospective analysis included 62 children, with a median age of 15.5 years, who had failed previous biologic treatments. Among them, 35 had Crohn's disease and 27 had ulcerative colitis, with 76% having failed at least two biologic agents. The most common dual therapy combinations were anti-tumor necrosis factor (anti-TNF) with vedolizumab, and anti-TNF with ustekinumab. Clinical remission rates at 3, 6, and 12 months were 35%, 50%, and 63%, respectively, indicating significant effectiveness. However, adverse events occurred in 47% of cases, with 8 considered serious and leading to therapy discontinuation in 6 children.
These results suggest that dual biologic therapy may be a viable option for treating pediatric IBD resistant to other treatments, but clinicians must carefully weigh the benefits against the risk of serious adverse events.