Sustainability of biologic treatment in paediatric patients with Crohn's disease: population-based registry analysis

HRADSKY, Ondrej, Ivana COPOVA, Marianna DURILOVA, Denis KAZEKA, Tereza LERCHOVA, Katarina MITROVA, Jan SCHWARZ, Romana VETROVCOVA, Nabil EL-LABABIDI, Eva KARASKOVA, Maria VEGHOVA-VELGANOVA, Astrid SULAKOVA, Lucie GONSORCIKOVA, Markéta SOBOTKOVÁ, Ivana ZENISKOVA, Martin ZIMEN, Martin BORTLIK a Jiri BRONSKY. Sustainability of biologic treatment in paediatric patients with Crohn's disease: population-based registry analysis. Pediatric Research. London: Nature Publishing Group, 2024, 9 s. ISSN 0031-3998. Dostupné z: https://dx.doi.org/10.1038/s41390-023-02913-7.

Základní údaje

• Originální název: Sustainability of biologic treatment in paediatric patients with Crohn's disease: population-based registry analysis
• Autoři: HRADSKY, Ondrej, Ivana COPOVA, Marianna DURILOVA, Denis KAZEKA, Tereza LERCHOVA, Katarina MITROVA, Jan SCHWARZ, Romana VETROVCOVA, Nabil EL-LABABIDI, Eva KARASKOVA, Maria VEGHOVA-VELGANOVA, Astrid SULAKOVA, Lucie GONSORCIKOVA, Markéta SOBOTKOVÁ, Ivana ZENISKOVA, Martin ZIMEN, Martin BORTLIK a Jiri BRONSKY.
• Vydání: Pediatric Research, London, Nature Publishing Group, 2024, 0031-3998.

Další údaje

• Originální jazyk: angličtina
• Typ výsledku: Článek v odborném periodiku
• Obor: 30209 Paediatrics
• Stát vydavatele: Velká Británie a Severní Irsko
• Utajení: není předmětem státního či obchodního tajemství
• WWW: URL
• Impakt faktor: Impact factor: 3.600 v roce 2022
• Organizační jednotka: Lékařská fakulta
• Doi: http://dx.doi.org/10.1038/s41390-023-02913-7
• UT WoS: 001114079400002
• Klíčová slova anglicky: Crohn’s disease; biologic treatment; paediatric patients
• Štítky: 14110317
• Příznaky: Mezinárodní význam, Recenzováno

Anotace

BackgroundWe aimed to evaluate the predictors of sustainability of biologic drugs for paediatric patients with Crohn's disease (CD).MethodsThe Czech National Prospective Registry of Biologic and Targeted Therapy of Inflammatory Bowel Disease (CREdIT) was used to identify the biologic treatment courses in paediatric patients with CD. Mixed-effects Cox models and propensity score analyses were employed to evaluate predictors of treatment sustainability.ResultsAmong the 558 observations of 473 patients, 264 were treated with adalimumab (47%), 240 with infliximab (43%), 41 with ustekinumab (7%), and 13 with vedolizumab (2%). Multivariable analysis revealed higher discontinuation risk with infliximab compared to adalimumab (HR = 0.600, 95%CI 0.389-0.926), both overall and in first-line treatment (HR = 0.302, 95%CI 0.103-0.890). Infliximab versus adalimumab was associated with shorter time to escalation (HR = 0.094, 95%CI 0.043-0.203). Propensity-score analysis demonstrated lower sustainability of infliximab (HR = 0.563, 95%CI 1.159-2.725). The time since diagnosis to treatment initiation (HR = 0.852, 95%CI 0.781-0.926) was the most important predictor. Baseline immunosuppressive therapy prolonged sustainability with infliximab (HR = 2.899, 95%CI 1.311-6.410).ConclusionsGiven the results suggesting shorter sustainability, the need for earlier intensification and thus higher drug exposure, and the greater need for immunosuppression with infliximab than with adalimumab, the choice of these drugs cannot be considered completely equitable.ImpactOur study identified predictors of sustainability of biologic treatment in paediatric patients with Crohn's disease, including adalimumab (versus infliximab), early initiation of biologic treatment, and normalised baseline haemoglobin levels. Infliximab treatment was associated with earlier intensification, higher drug exposure, and a greater need for immunosuppression.Parents and patients should be fully informed of the disadvantages of intravenous infliximab versus adalimumab during the decision-making process.This study emphasises the importance of not delaying the initiation of biologic therapy in paediatric patients with Crohn's disease.