Earlier anti-TNF-α medication helps ensure treatment success in paediatric IBD

First-line treatment with tumour necrosis factor-α (TNF-α) blockers is both safe and effective in children with inflammatory bowel disease (IBD), according to a recent study. Early drug initiation even cuts the likelihood of treatment failure and leads to fewer extraintestinal symptoms.

Drawing from the prospective, multicentre CEDATA-GPGE registry study, the current analysis included 487 patients (mean age 11.9 years, 59.1 percent boys) treated with a biological agent at least once between June 2004 and November 2020. Most of the participants (n=348; 71.5 percent) had been diagnosed with Crohn’s disease, while 21.8 percent (n=106) had ulcerative colitis. The remaining 33 patients had unclassified IBD. [Front Pediatr 2022;doi:10.3389/fped.2022.903677]

Overall, anti-TNF-α medication was effective, yielding an 82.7-percent corticosteroid-free remission rate after 1 year, which remained largely stable at 2 years (87 percent) and 5 years (88.9 percent).

At the time of biological drug prescription, Crohn’s disease activity was deemed to be moderate, with an average paediatric Crohn’s disease activity index (PCDAI) score of 29.3. Remission (PCDAI <15) was detected in 20.4 percent of patients, while 52.3 percent still had severe disease activity (PCDAI ≥30). Meanwhile, ulcerative colitis patients had generally mild disease at the time of prescription, with an average paediatric ulcerative colitis activity index (PUCAI) score of 35.5.

In both the Crohn’s disease and ulcerative colitis subgroups, patients who were treated with biologics for first-line vs second-line intervention had significantly worse disease activity according to PCDAI (p<0.001) and PUCAI (p=0.009) scores.

After propensity-score adjustments, Crohn’ patients who were given first-line biologics achieved comparable disease activity as their second-line comparators at the next doctor’s appointment (p=0.262).

Early treatment initiation bears additional benefits

Cox regression analysis revealed that initiating medication early reduced the likelihood of treatment failure (hazard ratio [HR] for longer time since diagnosis, 1.009, 95 percent confidence interval [CI], 1.006–1.012; p<0.001). The same was true for prescribing biologics as first-line treatment (HR, 0.485, 95 percent CI, 0.378–0.622; p<0.001).

Similarly, first-line biologic treatment reduced the risk of extraintestinal manifestations (HR, 0.316, 95 percent CI, 0.224–0.444; p<0.001).

“Anti-TNF-α therapy in children is safe, adverse events were mostly mild,” the researchers said. “[C]omplications such as the development of an adverse psoriasis were observed in approximately 13 percent of patients.”

“[A]nti-TNF agents should be considered early in the treatment regimen in children with moderate-to-severe disease activity or in those who do not reach clinical and biochemical remission after induction with exclusive enteral nutrition or corticosteroids,” they added.