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Michael Due Larsen, Niels Qvist, Jan Nielsen, Jens Kjeldsen, Rasmus Gaardskær Nielsen, Bente Mertz Nørgård, Use of Anti-TNFα Agents and Time to First-time Surgery in Paediatric Patients with Ulcerative Colitis and Crohn’s Disease, Journal of Crohn's and Colitis, Volume 10, Issue 6, June 2016, Pages 650–656, https://doi.org/10.1093/ecco-jcc/jjw017
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Abstract
It is debated whether the need for surgery has changed following introduction of anti-TNFα agents in the treatment of paediatric ulcerative colitis [UC] and Crohn’s disease [CD]. We aimed to describe the implementation of anti-TNFα agents in paediatric patients, and the need of first-time surgery before and after introduction of anti-TNFα agents.
In the Danish National Patient Registry, we identified incident paediatric patients diagnosed from 1998. We calculated the proportion of patients receiving anti-TNFα agents within 5 years from diagnosis, and the cumulative 5 year proportion of surgery, according to calendar periods of diagnosis.
At the end of our study period [2007 and 2008], 29–41% of CD children were treated with anti-TNFα agents within 5 years, and for UC children 17–19%. In 1278 CD patients, the 5 year cumulative proportions of surgery were 14.6–15.6% for children diagnosed in 1998–2008 and 9.7% (95% confidence interval [CI]: 6.7–13.7) for those diagnosed in 2009–2013. In 1468 UC patients, the cumulative proportion of surgery suggested a decline in patients diagnosed after mid 2005, and the hazard ratio of surgery was 0.64 [95% CI: 0.47–0.86] after the introduction of anti-TNFα agents compared with before. For UC patients diagnosed in 2009–2013, the 5 year cumulative proportion of surgery was 7.6% [95% CI: 5.2–11.2].
This nationwide study showed an extensive use of anti-TNFα agents at the end of our study period. For UC children, our data suggest a decline in the proportion of surgery in the period of increasing use of anti-TNFα agents.
