Su2027 - Phenotypic Variation in Pediatric IBD by Age: A Multi-Centre Inception Cohort Study of the Canadian Children IBD Network

Dhaliwal, Jasbir; Church, Peter; Mack, David R.; Huynh, Hien Q.; Jacobson, K; El‐Matary, Wael; deBruyn, Jennifer; Otley, Anthony; Deslandres, Colette; Sherlock, Mary; Critch, Jeff; Bax, Kevin; Seidman, Ernest G.; Rashid, Mohsin; Jantchou, Prevost; Issenman, Robert M.; Muise, Aleixo M.; Benchimol, Eric I.; Wine, Eytan; Carroll, Matthew; Lawrence, Sally; Limbergen, Johan Van; Walters, Thomas D.; Griffiths, Anne M.

doi:10.1016/s0016-5085(18)32371-0

Gastroenterology

2018

DOI: 10.1016/s0016-5085(18)32371-0

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Su2027 - Phenotypic Variation in Pediatric IBD by Age: A Multi-Centre Inception Cohort Study of the Canadian Children IBD Network

Jasbir Dhaliwal¹,

Peter Church²,

David R. Mack³

et al.

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“…Previous studies in VEOIBD patients have identified specific characteristics at presentation. IBD unclassified (IBD-U) is more common, colonic disease predominates, and ileal disease is rare (5)(6)(7)(8)(9).…”

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confidence: 99%

Progression to Anti-TNF Treatment in Very Early Onset Inflammatory Bowel Disease Patients

Eindor-Abarbanel

Meleady

Lawrence

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Limited data are currently available regarding anti-tumor necrosis factor (TNF) use and outcomes in very early onset inflammatory bowel disease (VEOIBD) patients. We aimed to assess the long-term outcomes and time to progression to anti-TNF treatment in VEOIBD patients. Methods: We retrospectively reviewed IBD patients diagnosed under 6 years of age, between January 2005 and December 2019, from the British-Columbia (BC) Pediatric IBD database. Demographic data, disease characteristics, disease location and severity were documented. Data on anti-TNF treatment at initiation and during follow up including type of biologic, dosing, and response were collected. Kaplan-Meier curves were used to assess the number of years to progression to anti-TNF treatment and the parameters influencing commencement. Results: Eighty-nine patients with VEOIBD were diagnosed during the study period. Median age at diagnosis was 3.8 years [interquartile range (IQR) 2.6-5.1], 45.3% had Crohn disease (CD) and 62.8% were males. Median duration of follow up was 6.39 years ). Anti-TNF treatment was started on 39.5% of patients and 7.0% underwent surgery. Rapid progression to biologic treatment was associated with Perianal fistulizing disease or stricturing disease in CD patients (P = 0.026, P = 0.033, respectively), and disease severity (P = 0.017) in ulcerative colitis (UC) patients. The median dose of infliximab at 1 year was 10 mg/kg (IQR 7.5-11) and a median dose interval of 4.5 weeks (IQR 4-6). Clinical remission was reported in 61.8% of patients on their first biologic agent. Conclusions: The response rate was higher than previously reported and might be due to higher infliximab dosing with shorter infusion intervals than standard dosing.

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confidence: 99%

Progression to Anti-TNF Treatment in Very Early Onset Inflammatory Bowel Disease Patients

Eindor-Abarbanel

Meleady

Lawrence

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…2 Crohn’s disease (CD) predominates over ulcerative colitis, accounting for 65.6% of pediatric IBD based on national administrative data up until 2010, 2 and occurring in 62% of 1146 children in the Canadian Children IBD Network inception cohort study. 3…”

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Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease

Mack

Benchimol

Critch

et al. 2018

Journal of the Canadian Association of Gastroenterology

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Background & AimsWe aim to provide guidance for medical treatment of luminal Crohn’s disease in children.MethodsWe performed a systematic search of publication databases to identify studies of medical management of pediatric Crohn’s disease. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. We developed statements through an iterative online platform and then finalized and voted on them.ResultsThe consensus includes 25 statements focused on medical treatment options. Consensus was not reached, and no recommendations were made, for 14 additional statements, largely due to lack of evidence. The group suggested corticosteroid therapies (including budesonide for mild to moderate disease). The group suggested exclusive enteral nutrition for induction therapy and biologic tumor necrosis factor antagonists for induction and maintenance therapy at diagnosis or at early stages of severe disease, and for patients failed by steroid and immunosuppressant induction therapies. The group recommended against the use of oral 5-aminosalicylate for induction or maintenance therapy in patients with moderate disease, and recommended against thiopurines for induction therapy, corticosteroids for maintenance therapy, and cannabis in any role. The group was unable to clearly define the role of concomitant immunosuppressants during initiation therapy with a biologic agent, although thiopurine combinations are not recommended for male patients. No consensus was reached on the role of aminosalicylates in treatment of patients with mild disease, antibiotics or vedolizumab for induction or maintenance therapy, or methotrexate for induction therapy. Patients in clinical remission who are receiving immunomodulators should be assessed for mucosal healing within 1 year of treatment initiation.ConclusionsEvidence-based medical treatment of Crohn’s disease in children is recommended, with thorough ongoing assessments to define treatment success.

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Su2027 - Phenotypic Variation in Pediatric IBD by Age: A Multi-Centre Inception Cohort Study of the Canadian Children IBD Network

Cited by 2 publications

References 0 publications

Progression to Anti-TNF Treatment in Very Early Onset Inflammatory Bowel Disease Patients

Progression to Anti-TNF Treatment in Very Early Onset Inflammatory Bowel Disease Patients

Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease

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