How Has the Disease Course of Pediatric Ulcerative Colitis Changed Throughout the Biologics Era? A Comparison with the IBSEN Study

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2022 Sep 26

PMID 36161040

Authors

Yiyoung Kwon

Eun Sil Kim

Yon Ho Choe

Mi Jin Kim

Affiliations

Soon will be listed here.

Abstract

Background: In Korea, infliximab was approved for use in children with ulcerative colitis (UC) in October 2012.

Aim: To compare the clinical course of UC before and after the introduction of biological agents, and to compare with the IBSEN study.

Methods: Patients under 18 years of age, who were diagnosed with UC and followed from January 2003 to October 2020, were included in the study. Group A ( = 48) was followed for at least 2 years between January 2003 and October 2012, and Group B ( = 62) was followed for at least 2 years between November 2012 and October 2020. We compared endoscopic remission, drug composition, relapse rate, steroid-free period, and the quality of life of each group. We plotted the clinical course of the included patients using the pediatric UC activity index score, and compared our patients with those in the IBSEN study.

Results: After 2 years of treatment, colonoscopy evaluation revealed different outcomes in the two treatment groups. Remission was confirmed in 14 patients (29.2%) of Group A, and in 31 patients (50.0%) of Group B ( < 0.012). The median cumulative corticosteroid-free period was 3.0 years in Group A and 4.4 years in Group B. Steroid-free period of Group B was significantly longer than that of Group A ( < 0.001). There was a statistically significant difference between the two groups in evaluation of the relapse rate during the observation period ( < 0.001). The plotted clinical course graphs of Group A showed similar proportions to the graphs in the IBSEN study. However, in Group B, the proportion of patients corresponding to curve 1 (remission or mild severity after initial high activity) was high at 76% (47/62).

Conclusion: The incidence of relapse has decreased and the steroid-free period has increased after the introduction of the biological agent. The clinical course also showed a different pattern from that of IBSEN study. The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC.

Citing Articles

Long-term prognosis and clinical practice for new-onset ulcerative colitis in the era of biologics: A Japanese retrospective study.

Moroi R, Kakuta Y, Obara T, Shimoyama Y, Naito T, Shiga H JGH Open. 2023; 7(10):682-689.

PMID: 37908295 PMC: 10615172. DOI: 10.1002/jgh3.12957.

References

Hagelund L, Stallknecht S, Jensen H . Quality of life and patient preferences among Danish patients with ulcerative colitis - results from a survey study. Curr Med Res Opin. 2020; 36(5):771-779. DOI: 10.1080/03007995.2020.1716704. View

Colombel J, Rutgeerts P, Reinisch W, Esser D, Wang Y, Lang Y . Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011; 141(4):1194-201. DOI: 10.1053/j.gastro.2011.06.054. View

Fiorino G, Navarro Cortes P, Ellul P, Felice C, Karatzas P, Silva M . Discontinuation of Infliximab in Patients With Ulcerative Colitis Is Associated With Increased Risk of Relapse: A Multinational Retrospective Cohort Study. Clin Gastroenterol Hepatol. 2016; 14(10):1426-1432.e1. DOI: 10.1016/j.cgh.2016.05.044. View

Kim H, Hann H, Hong S, Kim K, Ahn I, Song J . Incidence and natural course of inflammatory bowel disease in Korea, 2006-2012: a nationwide population-based study. Inflamm Bowel Dis. 2015; 21(3):623-30. DOI: 10.1097/MIB.0000000000000313. View

Mazzuoli S, Guglielmi F, Antonelli E, Salemme M, Bassotti G, Villanacci V . Definition and evaluation of mucosal healing in clinical practice. Dig Liver Dis. 2013; 45(12):969-77. DOI: 10.1016/j.dld.2013.06.010. View

. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis--the Porto criteria. J Pediatr Gastroenterol Nutr. 2005; 41(1):1-7. DOI: 10.1097/01.mpg.0000163736.30261.82. View

Worley G, Almoudaris A, Bassett P, Segal J, Akbar A, Ghosh S . Colectomy rates for ulcerative colitis in England 2003-2016. Aliment Pharmacol Ther. 2020; 53(4):484-498. DOI: 10.1111/apt.16202. View

Ali T, Lam D, Bronze M, Humphrey M . Osteoporosis in inflammatory bowel disease. Am J Med. 2009; 122(7):599-604. PMC: 2894700. DOI: 10.1016/j.amjmed.2009.01.022. View

Guo C, Wu K, Liang X, Liang Y, Li R . Infliximab clinically treating ulcerative colitis: A systematic review and meta-analysis. Pharmacol Res. 2019; 148:104455. DOI: 10.1016/j.phrs.2019.104455. View

10.

Jang E, Lee D, Kim J, Yang H, Lee S, Park Y . Age as a clinical predictor of relapse after induction therapy in ulcerative colitis. Hepatogastroenterology. 2009; 56(94-95):1304-9. View

11.

Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M . Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis. 2008; 40(10):821-6. DOI: 10.1016/j.dld.2008.03.014. View

12.

Farkas K, Lakatos P, Nagy F, Szepes Z, Miheller P, Papp M . Predictors of relapse in patients with ulcerative colitis in remission after one-year of infliximab therapy. Scand J Gastroenterol. 2013; 48(12):1394-8. DOI: 10.3109/00365521.2013.845906. View

13.

Abou Khalil M, Boutros M, Nedjar H, Morin N, Ghitulescu G, Vasilevsky C . Incidence Rates and Predictors of Colectomy for Ulcerative Colitis in the Era of Biologics: Results from a Provincial Database. J Gastrointest Surg. 2017; 22(1):124-132. DOI: 10.1007/s11605-017-3530-y. View

14.

Jung Y, Han M, Kim W, Park S, Cheon J . Incidence and Clinical Outcomes of Inflammatory Bowel Disease in South Korea, 2011-2014: A Nationwide Population-Based Study. Dig Dis Sci. 2017; 62(8):2102-2112. DOI: 10.1007/s10620-017-4640-9. View

15.

Ferrante M, Vermeire S, Fidder H, Schnitzler F, Noman M, Van Assche G . Long-term outcome after infliximab for refractory ulcerative colitis. J Crohns Colitis. 2010; 2(3):219-25. DOI: 10.1016/j.crohns.2008.03.004. View

16.

Rizzello F, Spisni E, Giovanardi E, Imbesi V, Salice M, Alvisi P . Implications of the Westernized Diet in the Onset and Progression of IBD. Nutrients. 2019; 11(5). PMC: 6566788. DOI: 10.3390/nu11051033. View

17.

Qiu Y, Chen B, Li Y, Xiong S, Zhang S, He Y . Risk factors and long-term outcome of disease extent progression in Asian patients with ulcerative colitis: a retrospective cohort study. BMC Gastroenterol. 2019; 19(1):7. PMC: 6327558. DOI: 10.1186/s12876-018-0928-2. View

18.

Lee J, Cheon J, Moon C, Park J, Hong S, Kim T . Do patients with ulcerative colitis diagnosed at a young age have more severe disease activity than patients diagnosed when older?. Digestion. 2010; 81(4):237-43. DOI: 10.1159/000253850. View

19.

Bitton A, Peppercorn M, Antonioli D, Niles J, Shah S, Bousvaros A . Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology. 2001; 120(1):13-20. DOI: 10.1053/gast.2001.20912. View

20.

Guthrie E, Jackson J, Shaffer J, Thompson D, Tomenson B, Creed F . Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn's disease. Am J Gastroenterol. 2002; 97(8):1994-9. DOI: 10.1111/j.1572-0241.2002.05842.x. View