Lower intestinal resection, stricture risks in CD seen in anti-TNF era

The increased use of immunosuppressants (IS) and antitumour necrosis factor (anti-TNF) appears to have facilitated positive changes in the natural history of paediatric-onset Crohn’s disease (CD), with lower rates of both intestinal resections and stricturing complications, a study reports.

The analysis used data from the EPIMAD registry and included 1,007 CD patients who were diagnosed at age <17 years and followed for a median of 8.8 years. Researchers defined three diagnostic periods: 1988–1993 (P1; pre-IS era), 1994–2000 (P2; pre-anti-TNF era), and 2001–2011 (P3; anti-TNF era). They then compared medication exposure and disease outcomes across the three diagnostic periods.

The 5-year IS and anti-TNF exposure rate increased over time from 33.9 percent in P1 to 76.5 percent in P3 and from 0 percent in P1 to 50.5 percent in P3, respectively. At the same time, the 5-year risk of intestinal resection significantly decreased over time (P1: 35 percent, P2: 31 35 percent, P3: 22 35 percent; p=0.0003, p_trend<0.0001), as well as between the pre-anti-TNF era and the anti-TNF era (P1+P2: 32 percent, P3: 22 percent; p=0.0007).

The 5-year risk of progression from inflammatory to stricturing behaviour also dropped substantially over time (P1: 27 percent, P2: 28 percent, P3: 20 percent; p=0.11, p_trend=0.041), as well as between the pre-anti-TNF era and anti-TNF era (P1+P2: 28 percent, P3: 20 percent; p=0.040).

Meanwhile, the 5-year risk of CD flare-related hospitalization remained stable over time (P1: 31 percent, P2: 31 percent, P3: 29 percent; p=0.76, p_trend=0.53).