Anti-TNF therapy for paediatric IBD: the Scottish national experience

Abstract

Complete accrual of the Scottish nationwide 'real-life' experience demonstrates moderate effectiveness of anti tumour necrosis factor agents in severe PIBD but duration of effect is limited; significant financial issues (drug cost-need for dose escalation and/or multiple biological usage) and safety issues exist.

Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease

“…Furthermore, satisfactory growth data was available for only 49% of our cohort of anti-TNF treated patients and full pubertal status data in 71% of these. As a 'real life' clinical experience from a nationwide group managed from 3 different centres over a 13 year period there is significant heterogeneity in the data due to changing treatment practices as new evidence emerged and differing rates of uptake of change within these centres; example of these include episodic dosing with IFX in 2000-2007 24 and induction only moving to induction plus maintenance given improved outcomes in those that continued 44 . Now treatment algorithms have changed considerably, IFX is given earlier on in treatment course in those patients with a severe phenotype such as those with widespread colonic deep mucosal ulceration, growth failure or severe perianal disease with episodic treatment abandoned and long term maintenance being the norm.…”

“…Ethical approval is not required in NHS Scotland for retrospective case record reviews with examination of departmental databases of service design/delivery, such as in PISA (the Paediatric-onset IBD Scottish Audit), comprising epidemiology 30 and the Scottish PIBD biologicals register 24 .…”

“…Data were collected as previously described on demographics including disease phenotype as per the Montreal criteria 25 ; biological schedule and regimen (induction only; induction then maintenance); medications (including corticosteroids, thiopurines and methotrexate) and surgery before, at and after biological start 24 . Disease activity was assessed Satisfactory growth data reflects 12 months prior to commencing anti-TNF therapy to 12 months after start date whilst extended growth data covers data collected up to 36 months after starting anti-TNF therapy.…”

“…One patient was excluded as was receiving recombinant human growth hormone as growth promoting treatment. Drug administration and dose adjustment was given as previously described 24 .…”

Adalimumab for the treatment of pediatric Crohn’s disease

“…Just recently, a similar experience from Scotland has reported a 45% remission rate at 12 months from therapy introduction [34]. A Dutch nationwide study evaluated the real-life efficacy of ADA in pediatric CD patients who had previously failed IFX.…”