Pediatr Gastroenterol Hepatol Nutr.  2019 Jul;22(4):358-368. 10.5223/pghn.2019.22.4.358.

Use of Anti-TNF Alpha Blockers Can Reduce Operation Rate and Lead to Growth Gain in Pediatric Crohn's Disease

• Woo MH
• Cho YH
• Sohn MJ
• Lee EJ
• Kim JW
• Moon JS
• Ko JS
• Kim HY

• KMID: 2451576
• DOI: http://doi.org/10.5223/pghn.2019.22.4.358

Abstract

PURPOSE
Pediatric Crohn's disease (CD) is directly related to growth and has a high probability of requiring surgical intervention(s); therefore, more active treatment for CD is required for children. This study investigated the impact of biologics on growth and disease course associated with surgery.
METHODS
This was a retrospective cohort study involving patients diagnosed with CD at the Seoul National University Children's Hospital (Seoul, Korea) between January 2006 and October 2017. The aim was to determine the characteristics of pediatric patients with CD and whether biologics affected growth and the surgical disease course.
RESULTS
Among patients who underwent surgery for CD, the mean number of operations per patient was 1.89. The mean time from initial diagnosis to surgery was 19.3 months. The most common procedure was fistulectomy (34%), followed by incision and drainage (25%). In all patients, the use of biologics increased the height (p=0.002) and body mass index (BMI) (p=0.005). Among patients who underwent surgery, height (p=0.004) and BMI (p=0.048) were increased in the group using biologics. Patients who used biologics exhibited a low operation rate only within 2 years after diagnosis, with no differences thereafter (p=0.027).
CONCLUSION
Although biologics could not mitigate the operation rate in pediatric patients who underwent surgery for CD, biological therapy delayed disease progression within 2 years of disease onset. Additionally, biologics conferred growth and BMI benefits in this window period. Therefore, it may be helpful to use biologics for optimal growth in pediatric patients with a high probability of undergoing future surgery.

Keyword

Crohn's disease; Children; Infliximab; Growth; Surgery

MeSH Terms

Biological Products
Biological Therapy
Body Mass Index
Child
Cohort Studies
Crohn Disease*
Diagnosis
Disease Progression
Drainage
Humans
Infliximab
Retrospective Studies
Seoul
Biological Products
Infliximab

Figure

• 

  Fig. 1 Frequency of procedure types in pediatric Crohn's disease. The most common operation was fistulectomy (34%), followed by incision and drainage (I&D) (25%), small bowel resection (15%), right hemicolectomy (11%), ileocolectomy (9%), and total colectomy (5%). I&D: incision and drainage.

• 

  Fig. 2 Box and Whisker plots of differences in height and BMI z-scores from diagnosis to follow-up according to the use of biologics. Height and BMI z-scores from diagnosis to October 2017 according to the use of biologics in all patients (A); in total operated patients (B); in perianal lesion operated patients (C); in non-perianal lesion operated patients (D); and in non-operated patients (E). BMI: body mass index.

• 

  Fig. 3 Cumulative operation rate in the operation group. Kaplan-Meier statistics comparing the duration from diagnosis to operation according to the use of biologics. Cumulative operation rates are shown in all patients (A); in all patients in the operation group (B); in the perianal lesion operated group (C); and in the non-perianal lesion operated group (D).

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