Basavaraj Kerur1, Jason T Machan2, Jason M Shapiro1, Carolina S Cerezo1, James Markowitz3, David R Mack4, Anne M Griffiths5, Anthony R Otley6, Marian D Pfefferkorn7, Joel R Rosh8, David J Keljo9, Brendan Boyle10, Maria Oliva-Hemker11, Marsha H Kay12, Shehzad A Saeed13, Andrew B Grossman14, Boris Sudel15, Michael D Kappelman16, Marc Schaefer17, Gitit Tomer18, Athos Bousvaros19, Trudy Lerer20, Jeffrey S Hyams20, Neal S LeLeiko21. 1. Pediatric Gastroenterology and Nutrition, Hasbro Children Hospital, Providence, Rhode Island; The Warren Alpert Medical School, Brown University, Providence, Rhode Island. 2. The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island. 3. Steven & Alexandra Cohen Children's Medical Center, Lake Success, New York. 4. Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 5. Hospital for Sick Children, Toronto, Ontario, Canada. 6. IWK Health Centre, Halifax, Nova Scotia, Canada. 7. James Whitcomb Riley Hospital for Children, Indianapolis, Indiana. 8. Goryeb Children's Hospital/Atlantic Health, Morristown, New Jersey. 9. Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 10. Nationwide Childrens Hospital, Columbus, Ohio. 11. Johns Hopkins University School of Medicine, Baltimore, Maryland. 12. The Cleveland Clinic Foundation, Cleveland, Ohio. 13. Cincinnati Children's Hospital, Cincinnati, Ohio. 14. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 15. University of Minnesota, Minneapolis, Minnesota. 16. University of North Carolina Chapel Hill, Chapel Hill, North Carolina. 17. Penn State Hershey Children's Hospital, Hershey, Pennsylvania. 18. Children's Hospital at Montefiore, Bronx, New York. 19. Boston Childrens Hospital, Boston, Massachusetts. 20. Connecticut Children's Medical Center, Hartford, Connecticut. 21. Pediatric Gastroenterology and Nutrition, Hasbro Children Hospital, Providence, Rhode Island; The Warren Alpert Medical School, Brown University, Providence, Rhode Island. Electronic address: Neal_LeLeiko@Brown.edu.
Abstract
BACKGROUND & AIMS: Up to 30% of patients with Crohn's disease (CD) require surgery within the first 5 years from diagnosis. We investigated the recent risk of bowel surgery in an inception cohort of pediatric patients with CD and whether early use of biologics (tumor necrosis factor antagonists) alters later disease course. METHODS: We collected data from the Pediatric Inflammatory Bowel Disease Collaborative Research Group registry on 1442 children (age, ≤16 y) diagnosed with CD from January 2002 through December 2014. Data were collected at diagnosis, 30 days following diagnosis, and then quarterly and during hospitalizations for up to 12 years. Our primary aim was to determine the 10-year risk for surgery in children with CD. Our secondary aim was to determine whether early use of biologics (<3 mo of diagnosis) affected risk of disease progression. RESULTS: The 10-year risk of first bowel surgery was 26%. The 5-year risk of bowel surgery did not change from 2002 through 2014, and remained between 13% and 14%. Most surgeries occurred within 3 years from diagnosis. The only predictor of surgery was disease behavior at diagnosis. CD with inflammatory behavior had the lowest risk of surgery compared to stricturing disease, penetrating disease, or both. We associated slowing of disease progression to stricturing or penetrating disease (but not surgery) with early use of biologics, but this effect only became evident after 5 years of disease. Our results indicate that biologics slow disease progression over time (hazard ratio, 0.85; 95% CI, 0.76-0.95). CONCLUSIONS: In an analysis of data from a registry of pediatric patients with CD, we found that among those with significant and progressing disease at or shortly after presentation, early surgery is difficult to prevent, even with early use of biologics. Early use of biologics (<3 mo of diagnosis) can delay later disease progression to stricturing and/or penetrating disease, but this affect could become evident only years after initial management decisions are made.
BACKGROUND & AIMS: Up to 30% of patients with Crohn's disease (CD) require surgery within the first 5 years from diagnosis. We investigated the recent risk of bowel surgery in an inception cohort of pediatric patients with CD and whether early use of biologics (tumor necrosis factor antagonists) alters later disease course. METHODS: We collected data from the Pediatric Inflammatory Bowel Disease Collaborative Research Group registry on 1442 children (age, ≤16 y) diagnosed with CD from January 2002 through December 2014. Data were collected at diagnosis, 30 days following diagnosis, and then quarterly and during hospitalizations for up to 12 years. Our primary aim was to determine the 10-year risk for surgery in children with CD. Our secondary aim was to determine whether early use of biologics (<3 mo of diagnosis) affected risk of disease progression. RESULTS: The 10-year risk of first bowel surgery was 26%. The 5-year risk of bowel surgery did not change from 2002 through 2014, and remained between 13% and 14%. Most surgeries occurred within 3 years from diagnosis. The only predictor of surgery was disease behavior at diagnosis. CD with inflammatory behavior had the lowest risk of surgery compared to stricturing disease, penetrating disease, or both. We associated slowing of disease progression to stricturing or penetrating disease (but not surgery) with early use of biologics, but this effect only became evident after 5 years of disease. Our results indicate that biologics slow disease progression over time (hazard ratio, 0.85; 95% CI, 0.76-0.95). CONCLUSIONS: In an analysis of data from a registry of pediatric patients with CD, we found that among those with significant and progressing disease at or shortly after presentation, early surgery is difficult to prevent, even with early use of biologics. Early use of biologics (<3 mo of diagnosis) can delay later disease progression to stricturing and/or penetrating disease, but this affect could become evident only years after initial management decisions are made.
Authors: Basavaraj Kerur; Eric I Benchimol; Karoline Fiedler; Marisa Stahl; Jeffrey Hyams; Michael Stephens; Ying Lu; Marian Pfefferkorn; Raza Alkhouri; Jennifer Strople; Judith Kelsen; Leah Siebold; Alka Goyal; Joel R Rosh; Neal LeLeiko; Johan Van Limbergen; Anthony L Guerrerio; Ross Maltz; Lina Karam; Eileen Crowley; Anne Griffiths; Melvin B Heyman; Mark Deneau; Keith Benkov; Joshua Noe; Dedrick Mouton; Helen Pappa; Joseph A Galanko; Scott Snapper; Aleixo M Muise; Michael D Kappelman Journal: Inflamm Bowel Dis Date: 2021-02-16 Impact factor: 5.325