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Antitumour necrosis factor alpha therapy reduces colectomy, corticosteroid use

31 Oct 2019

Treatment with the antitumour necrosis factor alpha (anti‐TNFα) appears to be beneficial in paediatric and adolescent patients with ulcerative colitis (UC), leading to lower colectomy rates within a period of 5 years and termination of corticosteroid use after 12 months, as shown in a recent study.

The study included 3,001 patients aged 0–20 years diagnosed with UC through 1995–2015 from Danish health registries (cohort 1: 1995–2003 [9 years], n=945; cohort 2: 2004–2015 [12 years], n=2,056). In Denmark, anti‐TNFα therapies are solely administered in the hospital for UC patients.

Overall, 334 patients received anti‐TNFα treatments, among whom 56 (16.8 percent) were prescribed corticosteroids in the subsequent 3‐month period. Use of corticosteroids declined with follow‐up: at 5.4 percent after 6 months and at 1.2 percent after 12 months.

There were 287 (9.6 percent) patients who underwent colectomies in a 5‐year period after the time of diagnosis. The 5‐year cumulative proportions of colectomy were 9.7 percent (95 percent CI, 8.4–11.1) in cohort 2 and 12.3 percent (10.4–14.6) in cohort 1. The adjusted 5‐year hazard ratio in cohort 2 vs cohort 1 was 0.76 (0.60–0.96).

The present data suggest that young UC patients who respond to anti‐TNFα therapy may reduce corticosteroid use, researchers said, adding that this should lead to an increased focus on an earlier introduction of anti‐TNFα in paediatric patients.

The study has important implications for patients. The researchers pointed out that the reduction in corticosteroid use applies especially for children with delayed growth, whereas postponing colectomy for a few years may also be an important treatment outcome for teenagers going through a time‐period with emotional distress and highly conscious of their body composition and appearance.

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