JL Kaplan et al. JPGN 2023; 76: 567-575. Open Access! Use, Durability, and Risks for Discontinuation of Initial and Subsequent Biologics in a Large Pediatric-Onset IBD Cohort
Methods: The authors analyzed pediatric inflammatory bowel disease (IBD) data from the ImproveCareNow Network registry (n= 17,649) between May 2006 and September 2016, including time to biologic initiation, choice of first subsequent biologics, biologic durability, and reasons for discontinuation
- 7585 (43%) were treated with a biologic agent before age 18. 50% of children with Crohn’s disease (CD) received a biologic compared to 25% of children with ulcerative colitis (UC)
- First biologic agents for all patients were anti-tumor necrosis factor agents (88% infliximab, 12% adalimumab)
- Probability of remaining on first biologic in patients with CD: 93% at 6 months, 85% at 12 months, 79% at 24 months, and 74% at 36 months
- Probability of remaining on first biologic in patients with UC: 84% at 6 months, 75% at 12 months, 66% at 24 months, and 55% at 36 months
- First biologics were discontinued because of loss of response (39%), intolerance (23%), and nonresponse (19%).
My take: This is an important study that shows that anti-TNF therapy durability was 79% in patients with CD and 66% in patients with UC at 2 years. This pediatric-specific information will help with counseling families when starting biologic therapy. There was improvement in durability after 2013 compared to prior -so perhaps perhaps even better durability is occurring in 2023. It is a little ironic that this study is from ImproveCareNow given that the results are quite dated. There have been a lot of changes in the last seven years. These include the widespread use of dose optimization/therapeutic drug levels and the approval of several new classes of targeted medications.
Related blog posts:
- Durability of Infliximab in Pediatric Crohn’s Disease
- Biologics in Children with Very Early Onset Inflammatory Bowel Disease
- Another Study Justifying Higher Infliximab Dosing in Pediatrics
- IBD Updates: Built-in Infliximab Dosing, Pouchitis in kids, PIBD Symposium & Aspen Meeting
- Combating Anti-Drug Antibodies with Immunomodulators in Pediatric IBD
- Expert Guidance on Inflammatory Bowel Disease (Part 2)