Novel therapies tied to drop in colectomy rate in paediatric UC

The risk of colectomy in paediatric onset ulcerative colitis (UC) has significantly decreased at the population level along with an increase in the use of immunosuppressants and antitumour necrosis factor (anti-TNF), reports a study.

Patients in the EPIMAD registry who had been diagnosed with UC before the age of 17 years between 1988 and 2011 were retrospectively followed up until 2013. The investigators compared medication exposure and disease outcomes between three diagnostic periods: 1988 to 1993 (period [P] 1; pre-IS era), 1994 to 2000 (P2; preanti-TNF era), and 2001 to 2011 (P3; anti-TNF era).

Overall, 337 patients (57 percent female) with a UC diagnosis were followed up for a median duration of 7.2 years (interquartile range, 3.8‒13.0). At 5 years, the exposure rates of IS and anti-TNF rose over time from 7.8 percent (P1) to 63.8 percent (P3) and from 0 percent (P1) to 37.2 percent (P3), respectively.

On the other hand, colectomy risk at 5 years significantly dropped over time (P1: 17 percent; P2: 19 percent; P3: 9 percent; p=0.045; p_trend=0.027) and between the preanti-TNF era (P1 + P2: 18 percent) and the anti-TNF era (P3: 9 percent; p=0.013).

The 5-year risk of disease extension remained stable across the three diagnostic periods (P1: 36 percent; P2: 32 percent; P3: 34 percent; p=0.31; p_trend=0.52) and between the preanti-TNF era (P1 + P2: 34 percent) and the anti-TNF era (P3: 34 percent; p=0.92).

In addition, the 5-year flare-related hospitalization risk showed a marked increase over time (P1: 16 percent; P2: 27 percent; P3: 42 percent; p=0.0012; p_trend=0.0006) and between the preanti-TNF era (P1 + P2: 23 percent) and the anti-TNF era (P3: 42 percent; p=0.0004).