Crohn's Disease Forum » Parents of Kids with IBD » Childhood Crohn's Progression Halted by Biologics


03-02-2018, 08:25 PM   #1
Maya142
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Childhood Crohn's Progression Halted by Biologics

More research!

Childhood Crohn's Progression Halted by Biologics
Need for surgery still high in first years after diagnosis

by Nancy Walsh, Senior Staff Writer, MedPage Today
March 02, 2018

The early use of biologic therapies helped prevent disease progression among children with Crohn's disease, but did not delay or avoid the need for surgery, a registry study found.

Among 1,442 children with Crohn's disease enrolled in the Pediatric Inflammatory Bowel Disease Collaborative Research Group registry from 2002 to 2014, the risk of disease progression from inflammation alone to stricturing or penetrating disease was lower for those receiving a biologic agent (HR 0.85, 95% CI 0.76-0.95, P=0.005), according to Neal S. LeLeiko, MD, PhD, of Brown University and Hasbro Children's Hospital in Providence, RI, and colleagues.

However, no effect on early surgery was seen with biologic use, the researchers reported online in Clinical Gastroenterology and Hepatology.
"Crohn's disease is a chronic, frequently progressive inflammatory disorder characterized by an exaggerated mucosal immune response of the gastrointestinal system in a genetically susceptible individual."

The course of disease tends to be worse in children than adults, with more than half of pediatric patients developing stricturing or penetrating complications within the first 5 years. However, whether recent advances in medical therapy -- widespread use of biologic medications -- has influenced the long-term course of disease remains uncertain.

Therefore, LeLeiko's group analyzed data from the registry, which includes 26 North American pediatric inflammatory bowel disease centers. Patients were diagnosed before age 16, and the types of bowel surgery included intestinal resection with primary anastomosis or diverting ostomy or strictureplasty. Disease location was classified as esophagus to jejunum, ileum to right colon, or transverse colon to rectum.

Early use of biologics was defined as initiation within 3 months of diagnosis.

Most patients were older than 6 at the time of diagnosis, 59% were boys, and median follow-up was 4.7 years.
At the time of enrollment, disease consisted only of inflammatory changes in 89.5%, but small numbers did already have stricturing and/or penetrating disease.

The rate of the first Crohn's-related bowel surgery was 4% at 1 year, 13.8% at 5 years, and 26% at 10 years.

Two-thirds of first bowel surgeries took place within 3 years of diagnosis, with 15.3% occurring during months 0 to 3, 18.2% during months 3 to 12, and 32.4% in months 12 to 36. The most common procedures were ileocecal resection and segmental resection with anastomosis of the small bowel.

The finding that the majority of bowel surgeries took place within the first few years "implies that there is very little you can do to head that off. The dye is cast," LeLeiko told MedPage Today. "We may make people feel a little better, but Crohn's is often a progressive disease."

Only the presence of stricturing or penetrating complications at baseline predicted the need for surgery over time, with no effects seen for the age of the patient, disease location, or the presence of perianal disease. In addition, no difference was seen in the 5-year risk of surgery among those enrolled in the registry from 2002-2007 versus those enrolled from 2008-2014, despite the greater use of biologics and earlier initiation of treatment.

The finding that there has not been a decrease in the 5-year risk of surgery since the advent of more powerful therapies may reflect the fact that substantial disease progression is already present at the time of diagnosis, according to the authors.

Among the 1,291 patients with inflammatory disease at baseline, 145 began biologic use within the first 3 months, which in most cases was infliximab (Remicade), LeLeiko noted.

While fewer patients with early biologic therapy progressed to have stricturing/penetrating disease, this benefit became apparent only after 5 years, as was the case for surgery.

"It should be noted that we found that in the group receiving early biologics, the risk of surgery appears to be paradoxically increased in the first 5 years from diagnosis," the researchers wrote. "This suggests that our practicing pediatric gastroenterologists may have selected the sicker patients to start biologics. If this is the case, then this introduces a bias that strengthens our findings, since it would be the sicker patients who are, in our study, experiencing the better long-term outcome -- i.e., less disease progression."

LeLeiko said that if aggressive treatment is started early, "it can have a positive effect down the road, after 5 to 6 years."

The study confirms the need to implement effective therapy before significant damage occurs, he concluded.


A limitation of the study, the researchers noted, was that there was some missing information about endoscopic and pathology findings in the registry.
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Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
03-03-2018, 09:33 PM   #2
Pilgrim
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The stat I always saw was 75-80% have surgery within 5 years. The stats in the article are way better!
03-03-2018, 09:37 PM   #3
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The rate of the first Crohn's-related bowel surgery was 4% at 1 year, 13.8% at 5 years, and 26% at 10 years.
I know, I have always seen that stat too....in multiple places. But here it gives different stats yet it says:

. In addition, no difference was seen in the 5-year risk of surgery among those enrolled in the registry from 2002-2007 versus those enrolled from 2008-2014, despite the greater use of biologics and earlier initiation of treatment.

The finding that there has not been a decrease in the 5-year risk of surgery since the advent of more powerful therapies may reflect the fact that substantial disease progression is already present at the time of diagnosis, according to the authors.
So was the first stat - 75-80% wrong?? Anyone know?
03-04-2018, 01:04 AM   #4
my little penguin
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Other authors reported that cumulative clinical recurrence rates in pediatric patients at 1 year, 5 years and 10 years were 50%, 73% and 77%, respectively [12].
From
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385302/


So the rate of having a second surgery needed in pediatric Crohns
After the first surgery is 50%,73%and 77%

Still looking for the 5 year one
I remember 75% without biologics and 30-40% woth biologics
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03-04-2018, 01:07 AM   #5
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https://www.healio.com/gastroenterol...crohns-disease
03-04-2018, 10:54 AM   #6
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https://academic.oup.com/ibdjournal/...2/2917/4561968
03-04-2018, 10:55 AM   #7
my little penguin
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http://adc.bmj.com/content/99/5/420?99%2F5%2F420=
03-04-2018, 10:57 AM   #8
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identified 1595 and 1175 incident cases of CD and UC respectively with a mean length of follow-up of 4.3 years/person. There were 216 (13.5%) and 73 (6.2%) surgeries for CD and UC patients between 1990 and 2009 respectively. In CD among thiopurine users, the absolute risk of sur- gery at 5 years for early thiopurine use vs. late was 15.3% (95% CI: 10.5– 22.1) vs. 22.1% (95% CI: 18.1–26.9) respectively. After adjustment, the early use of thiopurines was associated with a reduction in risk of first surgery of 39% (HR 0.61, 95% CI: 0.41–0.91) over the 20-year study period. In UC, early thiopurine use offered no additional benefit.


From
http://onlinelibrary.wiley.com/store...zb0fv&79268ac2


So basically numbers all over the map
Depending on what “group” they studied
03-04-2018, 11:03 AM   #9
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788945/
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