Early anti-TNF therapy reduces late B2 disease behavior development
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Early anti-tumor necrosis factor administration reduced late B2 development among pediatric patients with Crohn’s disease, according to a presenter.
“Previous studies investigating the natural history of Crohn's disease in children have demonstrated that inflammatory B1 disease behavior is most common at diagnosis and the disease is often localized in the ileocolonic region. Nonetheless, the risk for developing stricturing B2 and penetrating B3 disease behaviors, along with perianal fistulizing disease and the need for surgical resection, increases over time,” Duke Geem, MD, PhD, of the Emory School of Medicine and Children’s Healthcare of Atlanta Egleston Hospital, said at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting. “However, how anti-TNF medications affect the natural history of Crohn's disease in children remains to be fully elucidated.”
In a longitudinal study, researchers aimed to characterize the effect of anti-TNF therapy among 1,075 pediatric patients newly diagnosed with CD over a 5-year period. Measured outcomes included medication exposure and incidences of disease behaviors and surgery contingent upon anti-TNF administration and/or BMI z score (BMIz) normalization within 6 months of diagnosis.
According to analysis, the most common disease behavior at diagnosis was B1; this declined over the 5-year study period (92%-83.63%), whereas B2 demonstrated the largest increase (2.98%-10.6%). Compared with B1, the probability of anti-TNF exposure increased for B2 disease behavior (HR = 3.4; 95% CI, 2.26-4.81) with the optimal timing of anti-TNF for the prevention of B2 up to or within 12 months of CD diagnosis. The risk for surgery also increased for B2 compared with B1 (P < .0001). Children who received early anti-TNF and achieved BMIz normalization within 12 months of diagnosis had a decreased risk for surgery (P < .05).
“The probability of anti-TNF increases with time for pediatric Crohn's disease and anti-TNF within 12 months of diagnosis decreases the development of late B2 but not early B2,” Geem concluded. “In fact, early B2 development may be associated with the establishment and enrichment of transcriptomic pathways involved in inflammation and fibrosis, and once established, may not be amenable to anti-TNF therapy.”
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Geem D. Anti-tumor necrosis factor administration alters the natural history of stricturing Crohn's disease in children. Presented at: North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting; Dec. 12-18, 2021 (virtual meeting).
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