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Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood.
Ashton, James J; Borca, Florina; Mossotto, Enrico; Coelho, Tracy; Batra, Akshay; Afzal, Nadeem A; Phan, Hang T T; Stanton, Michael; Ennis, Sarah; Beattie, Robert Mark.
Afiliação
  • Ashton JJ; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
  • Borca F; Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.
  • Mossotto E; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
  • Coelho T; Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.
  • Batra A; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
  • Afzal NA; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
  • Phan HTT; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
  • Stanton M; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
  • Ennis S; NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
  • Beattie RM; Department of Paediatric Surgery, Southampton Children's Hospital, Southampton, UK.
Aliment Pharmacol Ther ; 49(4): 398-407, 2019 02.
Article em En | MEDLINE | ID: mdl-30628109
BACKGROUND: Anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti-TNF-therapy and surgery. AIM: To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). RESULTS: Eight-hundred-and-twenty-five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD-unclassified), mean age at diagnosis 13.6 years (1.6-17.6), 39.6% female. The prevalence of anti-TNF-treated patients increased from 5.1% to 27.1% (2007-2017), P = 0.0001. Surgical resection-rate fell (7.1%-1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%-2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection-rates were unchanged. Time from diagnosis to resection increased (1.6-2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007-2011 = 13.1 years, 2013-2017 = 11.9 years, P = 0.014). Resection-rate in anti-TNF-therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti-TNF-therapy <3 years post-diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti-TNF-therapy prevalence was the only significant predictor of resection-rate using multivariate regression (P = 0.011). CONCLUSIONS: The prevalence of anti-TNF-therapy increased significantly, alongside a decrease in surgical resection-rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti-TNF-therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.
Assuntos

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Colite Ulcerativa / Doença de Crohn / Fator de Necrose Tumoral alfa Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Aliment Pharmacol Ther Assunto da revista: FARMACOLOGIA / GASTROENTEROLOGIA / TERAPIA POR MEDICAMENTOS Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Colite Ulcerativa / Doença de Crohn / Fator de Necrose Tumoral alfa Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: Aliment Pharmacol Ther Assunto da revista: FARMACOLOGIA / GASTROENTEROLOGIA / TERAPIA POR MEDICAMENTOS Ano de publicação: 2019 Tipo de documento: Article