Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children

Basavaraj Kerur, Jason T. Machan, Jason M. Shapiro, Carolina S. Cerezo, James Markowitz, David R. Mack, Anne M. Griffiths, Anthony R. Otley, Marian D. Pfefferkorn, Joel R. Rosh, David J. Keljo, Brendan Boyle, Maria Oliva-Hemker, Marsha H. Kay, Shehzad A. Saeed, Andrew B. Grossman, Boris Sudel, Michael D. Kappelman, Marc Schaefer, Gitit TomerAthos Bousvaros, Trudy Lerer, Jeffrey S. Hyams, Neal S. LeLeiko

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1467-1473
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number9
DOIs
StatePublished - Sep 2018

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Biological Products
Crohn Disease
Disease Progression
Pediatrics
Registries
Inflammatory Bowel Diseases
Hospitalization
Tumor Necrosis Factor-alpha

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Kerur, B., Machan, J. T., Shapiro, J. M., Cerezo, C. S., Markowitz, J., Mack, D. R., ... LeLeiko, N. S. (2018). Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children. Clinical Gastroenterology and Hepatology, 16(9), 1467-1473. https://doi.org/10.1016/j.cgh.2018.02.027
Kerur, Basavaraj ; Machan, Jason T. ; Shapiro, Jason M. ; Cerezo, Carolina S. ; Markowitz, James ; Mack, David R. ; Griffiths, Anne M. ; Otley, Anthony R. ; Pfefferkorn, Marian D. ; Rosh, Joel R. ; Keljo, David J. ; Boyle, Brendan ; Oliva-Hemker, Maria ; Kay, Marsha H. ; Saeed, Shehzad A. ; Grossman, Andrew B. ; Sudel, Boris ; Kappelman, Michael D. ; Schaefer, Marc ; Tomer, Gitit ; Bousvaros, Athos ; Lerer, Trudy ; Hyams, Jeffrey S. ; LeLeiko, Neal S. / Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 9. pp. 1467-1473.
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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.",
author = "Basavaraj Kerur and Machan, {Jason T.} and Shapiro, {Jason M.} and Cerezo, {Carolina S.} and James Markowitz and Mack, {David R.} and Griffiths, {Anne M.} and Otley, {Anthony R.} and Pfefferkorn, {Marian D.} and Rosh, {Joel R.} and Keljo, {David J.} and Brendan Boyle and Maria Oliva-Hemker and Kay, {Marsha H.} and Saeed, {Shehzad A.} and Grossman, {Andrew B.} and Boris Sudel and Kappelman, {Michael D.} and Marc Schaefer and Gitit Tomer and Athos Bousvaros and Trudy Lerer and Hyams, {Jeffrey S.} and LeLeiko, {Neal S.}",
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language = "English (US)",
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issn = "1542-3565",
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Kerur, B, Machan, JT, Shapiro, JM, Cerezo, CS, Markowitz, J, Mack, DR, Griffiths, AM, Otley, AR, Pfefferkorn, MD, Rosh, JR, Keljo, DJ, Boyle, B, Oliva-Hemker, M, Kay, MH, Saeed, SA, Grossman, AB, Sudel, B, Kappelman, MD, Schaefer, M, Tomer, G, Bousvaros, A, Lerer, T, Hyams, JS & LeLeiko, NS 2018, 'Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children', Clinical Gastroenterology and Hepatology, vol. 16, no. 9, pp. 1467-1473. https://doi.org/10.1016/j.cgh.2018.02.027

Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children. / Kerur, Basavaraj; Machan, Jason T.; Shapiro, Jason M.; Cerezo, Carolina S.; Markowitz, James; Mack, David R.; Griffiths, Anne M.; Otley, Anthony R.; Pfefferkorn, Marian D.; Rosh, Joel R.; Keljo, David J.; Boyle, Brendan; Oliva-Hemker, Maria; Kay, Marsha H.; Saeed, Shehzad A.; Grossman, Andrew B.; Sudel, Boris; Kappelman, Michael D.; Schaefer, Marc; Tomer, Gitit; Bousvaros, Athos; Lerer, Trudy; Hyams, Jeffrey S.; LeLeiko, Neal S.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 9, 09.2018, p. 1467-1473.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Biologics Delay Progression of Crohn's Disease, but Not Early Surgery, in Children

AU - Kerur, Basavaraj

AU - Machan, Jason T.

AU - Shapiro, Jason M.

AU - Cerezo, Carolina S.

AU - Markowitz, James

AU - Mack, David R.

AU - Griffiths, Anne M.

AU - Otley, Anthony R.

AU - Pfefferkorn, Marian D.

AU - Rosh, Joel R.

AU - Keljo, David J.

AU - Boyle, Brendan

AU - Oliva-Hemker, Maria

AU - Kay, Marsha H.

AU - Saeed, Shehzad A.

AU - Grossman, Andrew B.

AU - Sudel, Boris

AU - Kappelman, Michael D.

AU - Schaefer, Marc

AU - Tomer, Gitit

AU - Bousvaros, Athos

AU - Lerer, Trudy

AU - Hyams, Jeffrey S.

AU - LeLeiko, Neal S.

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

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