New therapeutic strategies are associated with a significant decrease in colectomy rate in pediatric ulcerative colitis
Résumé
Objectives: We evaluated the impact of immunosuppressants (IS) and anti-tumor necrosis factor (TNF) introduction on ulcerative colitis (UC) long-term outcomes in a large population-based pediatric-onset cohort.
Methods: All patients included in the EPIMAD registry with a diagnosis of UC made before the age of 17 between 1988 and 2011 were followed up retrospectively until 2013. Medication exposure and disease outcomes were compared between three diagnostic periods: 1988 to 1993 (period [P]1; pre-IS era), 1994 to 2000 (P2; pre-anti-TNF era), and 2001 to 2011 (P3; anti-TNF era).
Results: A total of 337 patients (girls 57%) diagnosed with UC were followed up during a median duration of 7.2 years (IQR: 3.8-13.0). The IS and anti-TNF exposure rates at 5 years increased over time from 7.8% (P1) to 63.8% (P3) and from 0% (P1) to 37.2% (P3), respectively. In parallel, the risk of colectomy at 5 years decreased significantly over time (P1, 17%; P2, 19%; P3, 9%; p=0.045, p-trend=0.027), and between pre-anti-TNF era (P1+P2, 18%) and the anti-TNF era (P3, 9%) (p=0.013). The risk of disease extension at 5 years remained stable over time (P1, 36%, P2, 32%, P3, 34%, p=0.31, p-trend=0.52), and between the pre-anti-TNF era (P1+P2, 34%) and the anti-TNF era (P3, 34%) (p=0.92). The risk of flare-related hospitalization at 5 years significantly increased over time (P1, 16%; P2, 27%; P3, 42%; p=0.0012, p-trend=0.0006) and between pre-anti-TNF era (P1+P2, 23%) and anti-TNF era (P3, 42%) (p=0.0004).
Conclusions: In parallel with the increased use of IS and anti-TNF, an important decline in the risk of colectomy in pediatric-onset UC was observed at the population level.